Effective Endoscope for Endoscopic Retrograde Cholangiopancreatography in Patients with Roux-en-Y Anastomosis: A Single-, Double-, or 'Short' Double-Balloon Enteroscope?

摘要

We read with interest the article by Dellon et al. on a single-balloon enteroscope (SBE) for endoscopic retrograde cholangiopancreatography (ERCP) in four patients with Roux-en-Y anastomosis. In three of the four patients, cholangiography was successful with a 350-cm-long balloon catheter with the balloon deflated (two patients), and with a wire-guided esophageal balloon after failed cannu-lation with the 350-cm-long catheter (one patient). The 350-cm-long catheter was the only accessory available for cannulation in their unit that was long enough for the SBE. In two patients, dilation of the biliary stricture was attempted, but was unsuccessful because of failed guide-wire advancement through the stricture in one patient. The stricture was successfully dilated with a wire-guided esophageal balloon after SBE withdrawal because of the short accessory length in the other patient. They concluded that the SBE for ERCP was an effective device in patients with Roux-en-Y anastomosis, but had immature technology lacking long accessories. We believe that ERCP with a "short" double-balloon enteroscope (DBE) would achieve a high success rate in such patients.