ArticleSurgical endoscopy2026
Colonoscopy-assisted preplacement of guide tube for endoscopic retrograde cholangiopancreatography in patients with complex surgically altered anatomy.
Article in Surgical endoscopy, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundBalloon-assisted enteroscopy is limited by a small working channel and few compatible accessories. Herein, we assessed a novel endoscopic retrograde cholangiopancreatography (ERCP) involving a long-type single-balloon enteroscope (200 cm length; 2.8 mm channel), requiring dual-operator manipulation. Although standard in our centre, this technique's clinical limitations compared to single-operator long-colonoscopy ERCP remain unclear.
methodsThis retrospective study enrolled patients with complex surgically altered anatomy who underwent ERCP from 2021 to 2024, divided into the single-balloon enteroscopy-assisted ERCP (SBEAE) and long colonoscopy-assisted ERCP (LCAE) groups. The target site (i.e. native papilla or surgical anastomosis) was reached using a 'push and pull' method. In cases of failed biliopancreatic duct cannulation in the LCAE group, a plastic guide tube was inserted via the working channel with the distal end placed near the target site. The colonoscope was withdrawn, with the guide tube left in situ; a side-viewing duodenoscope was then advanced to reattempt cannulation. Biliary duct cannulation and overall procedure success rates were assessed.
resultsOverall, 101 patients [SBEAE: 43 (42.6%) and LACE: 58 (57.4%)] were included (mean age: 60.95 ± 12.9 years; male, n = 61), with Roux-en-Y anastomosis (n = 67; 66.3%), Billroth-II gastrectomy with Braun anastomosis (n = 18; 17.8%), and pancreaticoduodenectomy (n = 16; 15.9%). Indications for ERCP included biliary tract (83.2%) and pancreatic (16.8%) diseases. Intubation by SBE and colonoscopy was successful in 34 (79.1%)/55 (94.8%) in the SBEAE/LCAE groups, respectively (p = 0.077), with mean procedure times of 70.5 ± 19.7 and 57.6 ± 23.4 min (p < 0.001). Overall procedural success, defined as successful cannulation and completion of the intended intervention, was achieved in 26 (60.5%) and 52 (89.7%) patients, respectively (p < 0.001). Intubation and cannulation rates via subsequent duodenoscopy were 90% and 94.4%, respectively, (mean procedure time: 83.5 ± 21.1 min) after failed cannulation (n = 20) in the LCAE group.
conclusionsOur technique is effective and safe for patients with a complex surgically altered anatomy when performed by experienced endoscopists, showing superior endoscopic intubation and biliopancreatic duct cannulation compared to SBEAE.
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