Potential factors affecting success rate and long term outcome in single balloon enteroscopy-assisted therapeutic endoscopic retrograde cholangiopancreatography in patients with pancreaticojejunal anastomotic stenosis: a retrospective study.

Background: Pancreaticojejunal anastomotic stenosis (PJS) after pancreaticoduodenectomy (PD) is difficult to treat. Single-balloon enteroscope-assisted endoscopic retrograde pancreatography (SBE-assisted ERP) is a safe way to treat PJS with the strength of minimally invasion and repeatability, but since its technical difficulty and few patient number, data on long-term outcomes remain limited. The optimal treatment is still unknown. We aim to study the safety, effectiveness, and long-term outcome of single balloon enteroscopy-assisted (SBE-assisted) therapeutic ERP in patients with PJS in this study. Methods: The clinical information of patients undergoing SBE-assisted therapeutic ERP from March 2016 to March 2021 were retrospectively analyzed. All patients were diagnosed as PJS and without any contraindication for therapeutic endoscopy. Treatment details, postoperative complications, factors influencing technical success rate were evaluated. Long-term outcomes results were obtained by clinical or telephone follow-up. Results: Sixteen patients with median age of 51 years were included in this study, surgical reconstruction methods including PD with Whipple reconstruction, PD with Child reconstruction, pylorus-preserving pancreaticoduodenectomy (PpPD) with Whipple reconstruction. Eight patients were successfully treated. No serious complications happened. Risk factors for the failure of pancreaticojejunal anastomotic site identification include the digestive tract reconstruction sequence, pancreaticojejunostomy method, pancreatic duct tube implantation, pancreatic duct width before surgery, and pancreatic fistula during perioperative period. The median follow-up time was 77.2 months, the mean indwelling time of the stent was 62.3 months [interquartile range (IQR), 6.8-153.7 months]. Two of eight patients developed recurrent PJS. The variation in body mass index (BMI) was +2.46 in the non-recurrence group compared to -1.09 in the recurrence group and -2.12 in the endoscopic retrograde cholangiopancreatography (ERCP) treatment failure group. Conclusions: ERP intervention should be carried out early once PJS occurs in order to increase success rate. BMI is a crucial indicator which can reflex PJS rehabilitation degree during follow-up. In order to reduce PJS recurrence rate, a wider pancreatic stent and a longer stent indwelling time are recommended.

Clinical usefulness of a short-type, prototype single-balloon enteroscope for endoscopic retrograde cholangiopancreatography in patients with altered gastrointestinal anatomy: preliminary experiences.

BACKGROUND AND AIM: A limited number of endoscopic retrograde cholangiopancreatography (ERCP) accessories are compatible with the conventional single-balloon enteroscope (SBE) because of the latter's dimensions. The aim of the present study was to assess the utility of a prototype SBE that has a shorter working length and a wider channel than the conventional SBE. METHODS: ERCP procedures carried out between January 2012 and July 2013 using the short SBE prototype were reconstructions such as Billroth II (B-II), post-gastrectomy with Roux-en-Y (RY-G), and post-choledochojejunostomy with Roux-en-Y (RY-CJ). We retrospectively analyzed the rate of reaching the blind end of the intestine, the diagnostic success rate, the interventional success rate, and the frequency of related complications. RESULTS: Twenty-seven ERCP procedures on 18 patients analyzed comprised two B-II, 15 RY-G, and 10 RY-CJ reconstructions. With a mean procedure time of 56 min (range 40-150 min), the rate of reaching the blind end, the diagnostic success rate, and the interventional success rate were 24/27 (89%), 20/27 (74%), and 19/27 (70%), respectively. There were no major ERCP-related complications in any patient. CONCLUSIONS: The prototype short-type SBE appears safe and effective for use in ERCP, and is compatible with conventional endoscopy accessories.

Utilidad clínica de la enteroscopia de un solo balón: experiencia de 136 procedimientos en un centro privado de tercer nivel / Clinical usefulness of single balloon enteroscopy: experience of 136 procedures in a third level private hospital

Introducción: La enteroscopia de un solo balón (ESB) es una modalidad de enteroscopia profunda para el diagnóstico y tratamiento de la patología del intestino delgado. Objetivo: evaluar la aplicabilidad, seguridad y eficacia de la ESB en pacientes con sospecha de enfermedad del intestino delgado de un centro privado de tercer nivel. Pacientes y Métodos: Estudio retrospectivo. Se incluyó todos los pacientes con sospecha de enfermedades del intestino delgado y con indicación de ESB. Se utilizó el enteroscopio Olympus SIF-180Q (200cm de largo, canal de trabajo 2.8mm) acoplado a un sobre tubo de silicón. Se incluyeron 127 pacientes (63 mujeres y 64 hombres) con una media de edad de 50,9 años (7–92 años). Todos los procedimientos (136) fueron realizados bajo sedación asistida por anestesiólogo. Se registraron los datos demográficos, indicaciones, profundidad de inserción, tiempo del procedimiento, hallazgos, terapéutica y complicaciones. Resultados: Se realizaron 136 procedimientos (101 abordaje anterógrado, 35 retrógrado) en 127 pacientes (63 mujeres y 64 hombres). La principal indicación fue por hemorragia obscura (43,3%). Otras indicaciones fueron: diarrea (20,5%), síndrome anémico (7,1%), obstrucción intestinal parcial (6,3%), entre otros. El tiempo de inserción media, para la vía oral y anal fueron, 39 ± 14 minutos y 40 ± 11 minutos, respectivamente. La longitud media de progresión para la vía anterógrada fue 147 ± 88cm y por vía retrógrada fue de 97 ± 37 cm. El rendimiento diagnóstico se logró en el 70,4% de los casos. El tratamiento endoscópico se realizó en el 43,3%. No se presentaron complicaciones durante o después de los procedimientos. Conclusión: La ESB es un método seguro, bien tolerado y altamente eficaz para el estudio de la patología del intestino delgado. La ESB tiene alta sensibilidad diagnóstica y permite frecuentemente la intervención terapéutica...

Background: The single balloon enteroscopy (SBE) is a form of deep enteroscopy for diagnosis and treatment of diseases of the small bowell. The objective is evaluate the applicability, safety and efficacy of SBE in patients with suspected small bowel disease in a private tertiary care center. Patients and Methods: a retrospective study. We included all patients with suspected small bowel disease and indicating the SBE. We used the Olympus SIF-180Q enteroscopy (200cm long, 2.8mm working channel) coupled to a silicon overtube. A total of 127 patients were included (63 women and 64 men), mean age of 50.9 years (7 - 92 years). A total of 136 procedures were carried out under sedation assisted by an anesthesiologist. We recorded demographic data, indications, insertion depth, time of procedure, findings, treatment and complications. Results: from 136 procedures performed (101 were antegrade approach and 35 were retrograde). The main indication was obscure bleeding (43.3%). Other indications were: diarrhea (20.5%), anemic syndrome (7.1%), partial bowel obstruction (6.3%), among others. The average insertion time for the oral and anal were 39 ± 14 minutes and 40 ± 11 minutes, respectively. The average length of progression for the antegrade was 147 ± 88cm and retrograde was 97 ± 37 cm. The diagnostic yield was achieved in 70.4% of cases. Endoscopic treatment was performed in 43.3%. There were no complications during or after all procedures. Conclusion: The ESB is a safe, well tolerated and highly effective for study the pathology of the small intestine. The ESB has high diagnostic sensitivity and often allows therapeutic intervention. This retrospective study confirms that ESB is a valuable tool in evaluating small bowel diseases.

Enteroscopia de doble balón vs. enteroscopia de un solo balón en hemorragia digestiva de origen oscuro / Double-balloon enteroscopy vs. single balloon enteroscopy in obscure gastrointestinal bleeding

La enteroscopia de doble balón (EDB) ha demostrado ser una herramienta útil en el diagnóstico y el tratamiento de pacientes con hemorragia digestiva de origen oscuro (HDO). Más recientemente, la enteroscopia de balón único (ESB) es un nuevo método, que tiene las ventajas de la EDB yparece más fácil de manejar. Comparar la enteroscopia por balones en el diagnóstico de la HDO. Estudio retrospectivo comparativo. De noviembre 2007 a noviembre de 2008, se incluyeron pacientes con HDO a los cuales se les realizó enteroscopia de doble balón o balón único. Fueron utilizados: Enteroscopio doble balón Fujinon EN 450 5p-20 y EN 450 T5, 200 cm de longitud, diámetro externo de 8,5 y 9,3 mm y sobretubo de 12,2 y 13,2 mm y enteroscopio un solo balón Olympus 180-Q, diámetro externo de 9,2 mm y 13,2 mm sobretubo. Se evaluó: tiempo de montaje del sistema, del procedimiento, fluoroscopia, segmentos evaluados, hallazgos, procedimientos terapéuticos y complicaciones. Para proporciones se usó test chi cuadrado, para la data continua y variable dicotómica se usó Test T de Student para muestras independientes. Nivel de significación del 5% para el contraste. Se utilizó SPSS 14,0 para Windows para el análisis de datos. 43 pacientes EDB, 40 ESB. Edad y sexo fueron similares en ambos grupos. El tiempo de montaje fue significativamente menor con la ESB 1 min vs EDB 10 min (p <0,05). No hubo diferencias en el tiempo de fluoroscopia y los segmentos evaluados en ambos grupos (p> 0,05). El tiempo del procedimiento fue menor con la ESB 39 + / -11,8 en comparación EDB 50 + / -16,5 (p 0,001). Hubo una mayor proporción de hallazgos con ESB 84,6% con respecto a EDB 60,5% (p <0,05), siéndo el hallazgo más frecuente las angiodisplasias. Se realizó tratamiento endoscópico en el 75% de los pacientes en el grupode ESB y en el 18,6% grupo EDB (p <0,05). El diagnóstico y la terapéuticatuvieron mayor...

The double-balloon enteroscopy (DBE) has proven to be a useful tool in diagnosis and treatment of patients with obscure gastrointestinal bleeding (OGB). More recently, single balloon enteroscopy (SBE) is a new developed method, which has the advantages of DBE and it seems easierto handle. To compare balloon enteroscopy methods in the assessment of OGB. ItÊs a comparative retrospective study. From November 2007 to November 2008 subjects with OGB were enrolledand performed procedures of DBE or SBE. Two Fujinon systems were usedEN 450 5p-20 and EN 450 T5, 200 cm in length, outer diameter of 8.5 and 9.3 mm and overtube of 12.2 and 13.2 mm and one single balloon enteroscope Olympus 180-Q, outer diameter of 9.2 mm and 13.2 mm overtube. We recorded the time during: assembling the system, the procedure, fluoroscopy, segments evaluated, findings, therapeutic procedures and complications. For proportion used chi-square test, for continous data and dicotomic variable used student T test for independent sample. Significance level for contrast 5%. Used SPSS 14,0 for Windows for analysisdata. 43 patients EDB, 40 SBE. Age and sex were similar in bothgroups. The assembly time was significantly lower with the SBE 1 min vs DBE 10 min (p <0.05). There was no difference in the time of fluoroscopy and segments evaluated in both groups (p> 0.05). The procedure time was less with the SBE 39 + / -11.8 in comparasion to DBE 50 + / -16.5 (p 0.001). There was a greater proportion of findings with the SBE 84.6% (60.5% DBE) (p <0.05), being angiodysplasia most frecuent finding. We performed endoscopic therapy in 75% of patients in the group of SBE and in 18.6% of the DBE (p <0.05). The diagnostic and therapeutic impact was greater with SBE 70% vs 51.2% with DBE(p <0.05). The rate of complications was low in both groups with 2.3% (DBE) and 2.5% (SBE) (p> 0.05). The DBE and...