Balloon Enteroscopy-assisted ERC in Acute Cholangitis Cases with Surgically Altered Anatomy

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  • Inoue Yuma
    Third Department of Internal Medicine, University of Toyama Department of Gastroenterology, Hanwa Memorial Hospital
  • Hayashi Nobuhiko
    Third Department of Internal Medicine, University of Toyama
  • Yasuda Ichiro
    Third Department of Internal Medicine, University of Toyama

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  • 術後再建腸管例の胆管炎に対するバルーン内視鏡治療
  • ジュツゴ サイケン チョウカンレイ ノ タンカンエン ニ タイスル バルーン ナイシキョウ チリョウ

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<p>Background: Balloon enteroscopy-assisted endoscopic retrograde cholangiography (BE-ERC) is a newly developed cholangitis treatment technique for patients with surgically altered anatomy (SAA). This study was conducted to evaluate the efficacy of endoscopic treatment for acute cholangitis in patients with SAA. Methods: This single-center，retrospective study was conducted between April 2018 and April 2021. Results: The subjects of the study were 69 cases (male: 51 cases) of cholangitis. The mean age was 74.7 years. The reconstruction method was gastrectomy in 19 cases, pancreatoduodenectomy in 38 cases, hepaticojejunostomy in 10 cases, and gastrojejunal bypass in 2 cases (including Roux-en-Y reconstruction in 25 cases). The severity of cholangitis defined by Tokyo Guideline 2018 criteria was mild/moderate/severe in 32/31/6 cases. The etiology of cholangitis was bile stone/malignant stricture/stent occlusion/others in 33/20/5/13/5 cases. The procedure success rate of the first treatment, mainly BE-ERC, was 77% (53 cases). The failure cases were treated by repeat BE-ERC (n＝5) or EUS-guided biliary drainage (n＝5). Of the 69 cases, 63 (91%) were treated by endoscopic drainage; the remaining 6 cases were treated by percutaneous transhepatic biliary drainage (n＝5) or conservatively, with antibiotics (n＝1). Two patients (2.9%) died in the hospital. Two patients developed complications (perforation in 1 case and bleeding in 1 case). A review of the literature revealed success of BE-ERC in 480/585 cases (80.1%) of acute cholangitis cases with SAA and development of adverse events in 115 cases (4.2%). Conclusion: BE-ERC is useful for treating acute cholangitis in patients with SAA.</p>

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