Cap-assisted ERCP with a forward-viewing gastroscope as a rescue endoscopic intervention in patients with Billroth II anatomy.

Constantinos P. Anastassiades, Wajeeh Salah, Eric M. Pauli, Jeffrey M. Marks, Amitabh Chak

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

ERCP, especially therapeutic, is difficult in patients with Billroth II surgical reconstruction and is associated with a higher rate of complications. This has led to controversy on the choice between a forward-viewing and side-viewing endoscope for performing the procedure. A previous case series from Asia reported a high rate of success with a cap-fitted ERCP technique. To our knowledge, the utility of cap-assisted ERCP with a forward-viewing gastroscope when other techniques fail has not been reported. We describe and demonstrate a novel rescue approach using a cap-fitted, forward-viewing gastroscope in patients with Billroth II anatomy, when attempts with duodenoscopes, pediatric colonoscopes, and gastroscopes previously failed. Retrospective case series. Inclusion criteria were: (a) documented Billroth II anatomy; and (b) use of cap-assisted ERCP as a rescue intervention on the first endoscopic encounter after failed attempts to perform ERCP with a duodenoscope. Patients were excluded if they successfully underwent ERCP with a duodenoscope. One advanced endoscopist and one advanced endoscopy fellow performed all but one of the procedures. Five cap-assisted ERCP procedures were performed in three patients with Billroth II anatomy. A wide variety of diagnostic and therapeutic endoscopic maneuvers were technically feasible and successful, including the endoscopic treatment of an afferent limb perforation caused by a duodenoscope. Cap-assisted ERCP is a novel and underutilized technique that adds to the armamentarium of experienced therapeutic endoscopists. This approach may help ensure a successful endoscopic outcome and spare patients with Billroth II anatomy a percutaneous or surgical approach when ERCP with a duodenoscope, pediatric colonoscope or non-cap-fitted gastroscope fails.

Original languageEnglish (US)
Number of pages1
JournalSurgical endoscopy
Volume27
Issue number6
DOIs
StatePublished - Jun 2013

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Gastroscopes
Gastroenterostomy
Endoscopic Retrograde Cholangiopancreatography
Duodenoscopes
Anatomy
Colonoscopes
Pediatrics
Endoscopes
Therapeutics
Endoscopy
Extremities

All Science Journal Classification (ASJC) codes

  • Surgery

Cite this

Anastassiades, Constantinos P. ; Salah, Wajeeh ; Pauli, Eric M. ; Marks, Jeffrey M. ; Chak, Amitabh. / Cap-assisted ERCP with a forward-viewing gastroscope as a rescue endoscopic intervention in patients with Billroth II anatomy. In: Surgical endoscopy. 2013 ; Vol. 27, No. 6.
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Cap-assisted ERCP with a forward-viewing gastroscope as a rescue endoscopic intervention in patients with Billroth II anatomy. / Anastassiades, Constantinos P.; Salah, Wajeeh; Pauli, Eric M.; Marks, Jeffrey M.; Chak, Amitabh.

In: Surgical endoscopy, Vol. 27, No. 6, 06.2013.

Research output: Contribution to journalArticle

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