Int J Gastrointest Interv.  2023 Jul;12(3):115-122. 10.18528/ijgii230006.

Endoscopic retrograde cholangiopancreatography in patients with pancreaticoduodenectomy with and without the use of a rigidizing overtube

• Low DJ
• Yu A
• Liu C
• Ali FS
• Nakshabandi AA
• Coronel E
• Ge P
• Lee JH

• KMID: 2545061
• DOI: http://doi.org/10.18528/ijgii230006

Abstract

Background
Surgically altered anatomy remains a challenge when performing advanced endoscopic procedures, including endoscopic retrograde cholangiopancreatography (ERCP). While ERCP maintains a success rate of 90% to 95% in patients with native anatomy, the data are less robust for patients with post-pancreaticoduodenectomy (PD) anatomy. We conducted a retrospective analysis of the technical success (TS) and clinical success (CS) rates of ERCP in post-PD patients. In addition, we describe our experience using novel rigidizing overtubes to facilitate post-PD ERCP.
Methods
Patients with PD referred to our institution between 2006 and 2021 for ERCP were included. Major outcomes included the TS rate (successful biliary intervention) and the CS rate (improvement in patient symptomatology with or without normalization of bilirubin levels).
Results
In total, 47 patients underwent 102 ERCPs for biliary (n = 98) and pancreatic (n = 4) indications. The overall TS and CS rates were 82.4% and 75.5%, respectively. Rigidizing overtubes were utilized in 5 patients who underwent 11 ERCPs, with TS and CS rates of 90.9% and 90.9%, respectively. The overall adverse event rate was 4.9%, with no adverse events noted in cases with rigidizing overtubes.
Conclusion
Despite the challenges in ERCP in patients with surgically altered anatomy, this retrospective analysis demonstrates a moderately high TS rate with minimal adverse events. A rigidizing overtube may be utilized to improve TS and CS in patients with post-surgical anatomy.

Keyword

Carcinoma, pancreatic ductal; Cholangiopancreatography, endoscopic retrograde; Endoscopy, gastrointestinal; Pancreatic neoplasms; Pancreaticoduodenectomy