ERCP in patients with long-limb Roux-en-Y gastrojejunostomy and intact papilla
ERCP in patients with long-limb Roux-en-Y gastrojejunostomy and intact papilla
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DOI：
10.1067/mge.2002.126136
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发表时间：
2002-08-01
影响因子：
7.7
通讯作者：
Freeman, ML
中科院分区：
文献类型：
--
作者：
Wright, BE;Cass, OW;Freeman, ML
背景ERCP通过长肢Roux-en-Y手术治疗主要用于胆道或胰腺吻合的患者，但很少用于乳头完整的患者。回顾了6年内在胃空肠Roux-en-Y吻合术和乳头完整患者中尝试的所有ERCP手术。排除了既往接受过Billroth II手术或大乳头改变的患者。插管和治疗主要是在用前视结肠镜探查并在传入支中放置导丝后用十二指肠镜进行的。在某些情况下，将十二指肠镜拉入传入支，并将导丝引导球囊逆行进入传入支。作为前瞻性ERCP结局study.Results的一部分，所有患者均获得了30天的随访：在15例ERCP患者中，10例（67%）达到乳头，所有10例均进入胆管。3例患者在放置胰管支架后进行针刀预切乳头切开术。采用各种技术的胆道括约肌切开术在所有9例尝试的患者中均获得成功。其他操作包括取石、Oddi括约肌测压和胆道支架置入。最终诊断为Oddi括约肌功能障碍（6例）、恶性胆管狭窄（2例）、胆总管结石合并肿瘤（1例）和胆总管结石（1例）。并发症发生后3（12%）的25 ERCP程序，包括胰腺炎（1轻度，1中度）和出血（1轻度），所有患者的Oddi括约肌功能障碍。结论：诊断和治疗性ERCP最终成功的三分之二的患者与长肢胃空肠吻合术和完整的乳头。ERCP的成功主要取决于通过传入支推进十二指肠镜的能力。一旦十二指肠镜进入大乳头，先进的胆道和胰腺治疗技术是可行的。
Background. ERCP by means of long-limb Roux-en-Y surgical anastomoses has been reported primarily in patients with biliary or pancreatic anastamoses, but rarely in patients with an intact papilla.Methods. All ERCP procedures attempted over a 6-year interval in patients with Roux-en-Y gastrojejunostomies and an intact papilla were reviewed. Patients with a prior Billroth II operation or alteration of the major papilla were excluded. Cannulation and therapy were primarily performed with a duodenoscope after exploration and placement of a guidewire in the afferent limb with a forward-viewing colonoscope. In some cases the duodenoscope was pulled into the afferent limb with a wire-guided balloon passed retrograde into the afferent limb. A follow-up of 30 days was obtained for all patients as part of a prospective ERCP outcome study.Results: Of 15 patients in whom ERCP was attempted, the papilla was reached in 10 patients (67%), the bile duct being accessed in all 10. Needle-knife precut papillotomy after placement of a pancreatic duct stent was performed in 3 patients. Biliary sphincterotomy with a variety of techniques was successful in all 9 patients in whom it was attempted. Other maneuvers included stone extraction, sphincter of Oddi manometry, and biliary stent placement. Final diagnoses were sphincter of Oddi dysfunction (6), malignant biliary stricture (2), choledocholithiasis plus tumor (1), and choledocholithiasis (1). Complications Occurred after 3 (12%) of 25 ERCP procedures including pancreatitis (1 mild, 1 moderate) and bleeding (1 mild), all in patients with sphincter of Oddi dysfunction.Conclusions: Diagnostic and therapeutic ERCP was ultimately successful in two thirds of patients with long-limb gastrojejunostomies and an intact papilla. The success of the ERCP is determined primarily by ability to advance a duodenoscope through the afferent limb. Once the major papilla was accessed with a duodenoscope, advanced biliary and pancreatic therapeutic techniques were feasible.