Published online Jan 6, 2019. doi: 10.12998/wjcc.v7.i1.10
Peer-review started: October 29, 2018
First decision: November 22, 2018
Revised: December 16, 2018
Accepted: December 21, 2018
Article in press: December 21, 2018
Published online: January 6, 2019
Processing time: 69 Days and 9.3 Hours
Endoscopic retrograde cholangiopancreatography (ERCP) in patients with surgically altered anatomy has been a major challenge to gastrointestinal endoscopists with low success rates for reaching the target site as well as high complication rates. The knowledge of ERCP-related risk factors is important for reducing unexpected complications.
To identify ERCP-related risk factors for perforation in patients with surgically altered anatomy.
The medical records of 187 patients with surgically altered anatomy who underwent ERCP at our institution between April 2009 and December 2017 were retrospectively reviewed. An analysis of patient data, including age, sex, type of reconstruction, cause of surgery, aim of ERCP, success rate of reaching target site, success rate of procedure, adverse events, type of scope, time to reach the target site, and duration of procedure, was performed. In patients with Billroth-II reconstruction, additional potential risk factors were the shape of the inserted scope and whether the anastomosis was antecolic or retrocolic.
All patients (n = 187) had surgical anatomy, such as Billroth-I (n = 22), Billroth-II (n = 33), Roux-en-Y (n = 54), Child, or Whipple reconstruction (n = 75). ERCP was performed for biliary drainage in 43 cases (23%), stone removal in 29 cases (16%), and stricture dilation of anastomosis in 59 cases (32%). The scope was unable to reach the target site in 17 cases (9%), and an aimed procedure could not be accomplished in 54 cases (29%). Adverse events were pancreatitis (3%), hyperamylasemia (10%), cholangitis (6%), cholestasis (4%), excessive sedation (1%), perforation (2%), and others (3%). Perforation occurred in three cases, all of which were in patients with Billroth-II reconstruction; in these patients, further analysis revealed loop-shaped insertion of the scope to be a significant risk for perforation (P = 0.01).
Risk factors for perforation during ERCP in patients with surgically altered anatomy were Billroth-II reconstruction and looping of the scope during Billroth-II procedure.
Core tip: Endoscopic retrograde cholangiopancreatography (ERCP) for patients with surgically altered anatomy accompanies a high risk of perforation. This study identified that Billroth-II reconstruction was associated with high risk of perforation during ERCP procedure. Moreover, a looping shape of a scope during insertion in patients with Billroth-II reconstruction proved to be a more specific risk factor of perforation in ERCP.