井澤直哉先生の論文が、Journal of Clinical Medicine誌(Journal Citation Reports Impact Factor 2019 = 3.303)にpublishされました。
J Clin Med. 2021 Mar 6;10(5):1100. doi: 10.3390/jcm10051100.
Factors Affecting Technical Difficulty in Balloon Enteroscopy-Assisted Endoscopic Retrograde Cholangiopancreatography in Patients with Surgically Altered Anatomy
Naoya Izawa, Kohei Tsuchida, Keiichi Tominaga, Koh Fukushi, Fumi Sakuma, Ken Kashima, Yasuhito Kunogi, Mimari Kanazawa, Takanao Tanaka, Kazunori Nagashima, Takahito Minaguchi, Mari Iwasaki, Akira Yamamiya, Hidehito Jinnai, Akane Yamabe, Koki Hoshi, Takeshi Sugaya, Makoto Iijima, Kenichi Goda, Atsushi Irisawa
PMID: 33800779 DOI: 10.3390/jcm10051100
Success rates of balloon enteroscopy-assisted endoscopic retrograde cholangiopancreatography (BE-ERCP) for patients with a reconstructed intestinal tract after surgical procedures are unsatisfactory. We retrospectively investigated the factors associated with unsuccessful BE-ERCP. Ninety-one patients who had a reconstructed intestinal tract after gastrectomy or choledochojejunostomy were enrolled. Age, sex, operative method, malignancy, endoscope type, endoscopist’s skill, emergency procedure, and time required to reach the papilla/anastomosis were examined. The primary endpoints were the factors associated with unsuccessful BE-ERCP selective cannulation, while the secondary endpoints were the rate of reaching the papilla/anastomosis, causes of failure to reach the papilla/anastomosis, cannulation success rate, procedure success rate, and rate of adverse events. Younger age (odds ratio, 0.832; 95% CI, 0.706-0.982; p = 0.001) and Roux-en-Y partial gastrectomy (odds ratio, 54.9; 95% CI, 1.09-2763; p = 0.045) were associated with unsuccessful BE- ERCP. The rate of reaching the papilla/anastomosis was 92.3%, the success rate of biliary duct cannulation was 90.5%, procedure success rate was 78.0%, and the rate of adverse events was 5.6%. In conclusion, Roux-en-Y partial gastrectomy and younger age were associated with unsuccessful BE-ERCP. If BE-ERCP is extremely difficult to perform in such patients after Roux-en-Y partial gastrectomy, alternative procedures should be considered early.
Keywords: Roux-en-Y anastomosis; balloon enteroscopy; biliary intervention; endoscopic retrograde cholangiography.