Balloon Enteroscopy-Assisted Endoscopic Retrograde Cholangiopancreatography for the Treatment of Common Bile Duct Stones in Patients with Roux-en-Y Gastrectomy: Outcomes and Factors Affecting Complete Stone Extraction
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design
2.2. Patients
2.3. BE-ERCP Procedure
2.4. Definitions
2.5. Statistical Analyses
3. Results
3.1. Patients’ Characteristics
3.2. Scope Insertion and Biliary Cannulation in an Initial BE-ERCP
3.3. Ampullary Procedure for Stone Extraction at Initial BE-ERCP
3.4. Biliary Intervention and Complete CBD Stone Extraction in an Initial BE-ERCP
3.5. Potential Factors Affecting Complete CBD Stone Extraction
3.6. Adverse Events
4. Discussion
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Patients/sessions, n | 79/90 |
Age, years, median (IQR) | 79 (73–84) |
Sex, male/female, n | 62/17 |
ASA-PS, 2/3/4, n | 57/19/3 |
Reasons for gastrectomy, n (%) | |
Gastric cancer | 72 (91) |
Esophageal cancer | 1 (1) |
Malignant lymphoma | 1 (1) |
Gastric ulcer | 2 (3) |
Unknown | 3 (4) |
Diameter of the largest CBD, mm, median (IQR) | 14 (11–16) |
Size of the largest CBD stone, mm, median (IQR) | 10 (6–14) |
Number of CBD stones, n (%) | |
Debris | 2 (3) |
1 | 40 (51) |
2 | 15 (19) |
≥3 | 22 (28) |
Reaching the papilla of Vatar, n (%) | 73 (92) | |
Successful biliary cannulation, n (%) | 64 (81) | |
Detection of stones by cholangiogram, n (%) | 63 (80) | |
Overall procedure success, n (%) | 62 (78) | |
Complete stone extraction, n (%) | 42 (53) | |
Biliary stenting, n (%) | 20 (25) | |
Time to reaching the papilla, min, median (IQR) | 25 (11–40) | |
Time to biliary cannulation, min, median (IQR) | 25 (6–33) | |
Total procedural time, min, median (IQR) | 90 (67–120) | |
Adverse events, n (%) | 4 (5) | |
Perforation | moderate/severe | 1/1 (3) |
Pancreatitis | mild | 1 (1) |
Hypoxia | mild | 1 (1) |
Ampullary Procedure | n (%) |
Precut alone | 4 (6) |
EST alone | 6 (10) |
EPBD alone | 9 (14) |
EPLBD alone | 5 (8) |
Precut + EPBD | 12 (19) |
Precut + EPLBD | 5 (8) |
EST + EPBD | 12 (19) |
EST + EPLBD | 5 (8) |
None | 5 (8) |
Biliary Intervention | n(%) |
Balloon catheter | 46 (73) |
Basket catheter | 21 (29) |
ML | 22 (30) |
Plastic stent | 20 (27) |
ENBD | 2 (3) |
Variable | Complete Stone Extraction | Univariate | Multivariates | |||
---|---|---|---|---|---|---|
n | % | OR (95% CI) | p Value | OR (95% CI) | p Value | |
Age > 78 years old | 28/34 | 82 | 1.56 (0.47–5.12) | 0.55 | ||
Male | 46/57 | 81 | 2.09 (0.45–9.67) | 0.39 | ||
ASA-PS 3 or 4 | 13/16 | 81 | 1.22 (0.30–5.07) | >0.99 | ||
Initial BE-ERCP | 40/50 | 80 | 1.33 (0.35–5.03) | 0.73 | ||
Largest CBD diameter ≥ 14 mm | 23/36 | 64 | 0.06 (0.01–0.50) | 0.002 | 0.04 (0.003–0.58) | 0.018 |
Retroflex position | 26/29 | 90 | 3.67 (0.92–14.69) | 0.073 | 6.43 (1.12–36.81) | 0.037 |
Largest CBD stone size ≥ 10 mm | 27/39 | 69 | 0.18 (0.04–0.89) | 0.031 | 0.94 (0.11–8.15) | 0.96 |
Number of CBD stones ≥ 3 | 13/19 | 68 | 0.44 (0.13–1.52) | 0.20 | ||
EST/Precut | 36/43 | 84 | 2.25 (0.68–7.48) | 0.21 | ||
EPBD/EPLBD | 46/59 | 78 | 0.59 (0.07–5.35) | >0.99 | ||
Time from RYG to BE-ERCP > 4.9 years | 26/33 | 79 | 1.00 (0.31–3.26) | >0.99 |
Variable | Complete Stone Extraction | Univariate | ||
---|---|---|---|---|
n | % | OR (95% CI) | p Value | |
Age > 78 years old | 9/15 | 60 | 0.75 (0.19–2.97) | 0.74 |
Male | 21/31 | 68 | 3.15 (0.45–21.95) | 0.33 |
ASA-PS 3 or 4 | 4/7 | 57 | 0.70 (0.13–3.77) | 0.69 |
Initial BE-ERCP | 18/27 | 67 | 1.60 (0.34–7.46) | 0.69 |
Retroflex position | 15/18 | 83 | 6.25 (1.33–29.43) | 0.035 |
Largest CBD stone size ≥ 10 mm | 16/28 | 57 | 0.24 (0.03–2.22) | 0.21 |
Number of CBD stones ≥ 3 | 10/16 | 63 | 0.90 (0.23–3.52) | >0.99 |
EST/Precut | 16/22 | 73 | 2.67 (0.65–10.88) | 0.29 |
EPBD/EPLBD | 20/32 | 63 | 0.56 (0.05–5.97) | >0.99 |
Time from RYG to BE-ERCP > 4.9 years | 14/21 | 67 | 1.33 (0.34–5.27) | 0.74 |
Variable | Complete Stone Extraction | Univariate | ||
---|---|---|---|---|
n | % | OR (95% CI) | p Value | |
Age > 78 years old | 14/20 | 70 | 1.08 (0.28–4.20) | >0.99 |
Male | 24/33 | 73 | 2.67 (0.45–15.72) | 0.35 |
ASA-PS 3 or 4 | 8/11 | 73 | 1.26 (0.27–5.93) | >0.99 |
Initial BE-ERCP | 20/28 | 71 | 1.43 (0.33–6.26) | 0.71 |
Largest CBD diameter ≥ 14 mm | 16/28 | 57 | N.A. | 0.017 |
Retroflex position | 15/17 | 88 | 6.25 (1.15–34.12) | 0.037 |
Number of CBD stones ≥ 3 | 9/15 | 60 | 0.50 (0.13–2.00) | 0.48 |
EST/Precut | 19/25 | 76 | 2.38 (0.59–9.64) | 0.29 |
EPBD/EPLBD | 25/36 | 69 | 1.14 (0.09–13.89) | >0.99 |
Time from RYG to BE-ERCP > 4.9 years | 14/21 | 67 | 0.89 (0.23–3.54) | 0.74 |
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Obata, T.; Tsutsumi, K.; Kato, H.; Ueki, T.; Miyamoto, K.; Yamazaki, T.; Matsumi, A.; Fujii, Y.; Matsumoto, K.; Horiguchi, S.; et al. Balloon Enteroscopy-Assisted Endoscopic Retrograde Cholangiopancreatography for the Treatment of Common Bile Duct Stones in Patients with Roux-en-Y Gastrectomy: Outcomes and Factors Affecting Complete Stone Extraction. J. Clin. Med. 2021, 10, 3314. https://doi.org/10.3390/jcm10153314
Obata T, Tsutsumi K, Kato H, Ueki T, Miyamoto K, Yamazaki T, Matsumi A, Fujii Y, Matsumoto K, Horiguchi S, et al. Balloon Enteroscopy-Assisted Endoscopic Retrograde Cholangiopancreatography for the Treatment of Common Bile Duct Stones in Patients with Roux-en-Y Gastrectomy: Outcomes and Factors Affecting Complete Stone Extraction. Journal of Clinical Medicine. 2021; 10(15):3314. https://doi.org/10.3390/jcm10153314
Chicago/Turabian StyleObata, Taisuke, Koichiro Tsutsumi, Hironari Kato, Toru Ueki, Kazuya Miyamoto, Tatsuhiro Yamazaki, Akihiro Matsumi, Yuki Fujii, Kazuyuki Matsumoto, Shigeru Horiguchi, and et al. 2021. "Balloon Enteroscopy-Assisted Endoscopic Retrograde Cholangiopancreatography for the Treatment of Common Bile Duct Stones in Patients with Roux-en-Y Gastrectomy: Outcomes and Factors Affecting Complete Stone Extraction" Journal of Clinical Medicine 10, no. 15: 3314. https://doi.org/10.3390/jcm10153314
APA StyleObata, T., Tsutsumi, K., Kato, H., Ueki, T., Miyamoto, K., Yamazaki, T., Matsumi, A., Fujii, Y., Matsumoto, K., Horiguchi, S., Yasugi, K., Ogawa, T., Takenaka, R., & Okada, H. (2021). Balloon Enteroscopy-Assisted Endoscopic Retrograde Cholangiopancreatography for the Treatment of Common Bile Duct Stones in Patients with Roux-en-Y Gastrectomy: Outcomes and Factors Affecting Complete Stone Extraction. Journal of Clinical Medicine, 10(15), 3314. https://doi.org/10.3390/jcm10153314