Success Of Single-Balloon Enteroscope-Assisted Endoscopic Retrograde Colangiopancreatography In Patients With A Modified Anatomy

We would like to congratulate Drs. Espinel and Pinedo for their excellent results in single-ballon enteroscopy-assisted ERCP recently published in REED(1).We also want to share our experience. Between 2015 and 2021 we have performed 31 procedures in 26 patients. Half of the procedures (45.16%) were performed in patients with Roux-en-Y hepatic jejunostomy. Eight of these (22.80%) had prior primary bile duct surgery and six (19.35%) had prior Whipple surgery. The other half of the procedures (54.8%) presented native papilla: 10 (32.25%) subtotal gastrectomy and seven (22.58%) gastric bypass surgery. The main indication was choledocholithiasis in 21 procedures (67.74%), followed by benign biliary stricture (22.58%), bile leak (6.45%) and one (3.22%) biliary loop obstruction. We reached the papilla or bilioenteric anastomosis in 19 procedures (61.29%) and in 69.23% of the patients, respectively. It was possible to cannulate the bile duct and perform cholangiography in 17 procedures (54.83%), and 17 patients (65.38%). Finally, we achieved ERCP therapeutic success in 15 procedures (48.38%) and 15 patients (57.69%). In our center, we present lower success rate of therapeutic ERCP (29.4%) in patients with native papilla, compared to the one observed in hepatic-jejunostomies (71.43%), which is statistically significant (p = 0.04). Our results are similar to those previously published in the literature (2). It is essential to highlight that once we were able to reach the papilla or biliary anastomosis, we could cannulate 100% of the hepatic-jejunostomy compared to 55.56% of the native papilla patients. In our opinion, although the number of cases presented by Espinel and Pinedo is small, the cap is probably helpful to improve cannulation rates in patients with native papilla.