ERCP using balloon-assisted endoscopes versus EUS-guided treatment for common bile duct stones in Roux-en-Y gastrectomy

Tatsuya Sato; Yousuke Nakai; Hirofumi Kogure; Toshiyuki Mitsuyama; Masaaki Shimatani; Shinya Uemura; Takuji Iwashita; Yuki Tanisaka; Shomei Ryozawa; Takayoshi Tsuchiya; Takao Itoi; Toshifumi Kin; Akio Katanuma; Ken Kashima; Atsushi Irisawa; Atsuto Kayashima; Eisuke Iwasaki; Akihiro Yoshida; Mamoru Takenaka; Hitomi Himei; Hironari Kato; Atsuhiro Masuda; Hideyuki Shiomi; Kazumichi Kawakubo; Masaki Kuwatani; Takeshi Otsuka; Saburo Matsubara; Nobu Nishioka; Takeshi Ogura; Takaaki Tamura; Masayuki Kitano; Nobuhiko Hayashi; Ichiro Yasuda; Mitsuhiro Fujishiro

doi:10.1016/j.gie.2023.09.001

ERCP using balloon-assisted endoscopes versus EUS-guided treatment for common bile duct stones in Roux-en-Y gastrectomy

Gastrointest Endosc. 2024 Feb;99(2):193-203.e5. doi: 10.1016/j.gie.2023.09.001. Epub 2023 Sep 13.

Authors

Tatsuya Sato¹, Yousuke Nakai², Hirofumi Kogure¹, Toshiyuki Mitsuyama³, Masaaki Shimatani³, Shinya Uemura⁴, Takuji Iwashita⁴, Yuki Tanisaka⁵, Shomei Ryozawa⁵, Takayoshi Tsuchiya⁶, Takao Itoi⁶, Toshifumi Kin⁷, Akio Katanuma⁷, Ken Kashima⁸, Atsushi Irisawa⁸, Atsuto Kayashima⁹, Eisuke Iwasaki⁹, Akihiro Yoshida¹⁰, Mamoru Takenaka¹⁰, Hitomi Himei¹¹, Hironari Kato¹¹, Atsuhiro Masuda¹², Hideyuki Shiomi¹³, Kazumichi Kawakubo¹⁴, Masaki Kuwatani¹⁴, Takeshi Otsuka¹⁵, Saburo Matsubara¹⁵, Nobu Nishioka¹⁶, Takeshi Ogura¹⁶, Takaaki Tamura¹⁷, Masayuki Kitano¹⁷, Nobuhiko Hayashi¹⁸, Ichiro Yasuda¹⁸, Mitsuhiro Fujishiro¹

Affiliations

¹ Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
² Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan; Department of Endoscopy and Endoscopic Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
³ Division of Gastroenterology and Hepatology, Kansai Medical University Medical Center, Osaka, Japan.
⁴ First Department of Internal Medicine, Gifu University Hospital, Gifu, Japan.
⁵ Department of Gastroenterology, Saitama Medical University International Medical Center, Saitama, Japan.
⁶ Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan.
⁷ Center for Gastroenterology, Teine Keijinkai Hospital, Hokkaido, Japan.
⁸ Department of Gastroenterology, Dokkyo Medical University School of Medicine, Tochigi, Japan.
⁹ Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan.
¹⁰ Department of Gastroenterology and Hepatology, Faculty of Medicine, Kindai University, Osaka, Japan.
¹¹ Department of Gastroenterology and Hepatology, Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama University, Okayama, Japan.
¹² Division of Gastroenterology, Department of Internal Medicine, Graduate School of Medicine, Kobe University, Hyogo, Japan.
¹³ Division of Gastroenterology, Department of Internal Medicine, Graduate School of Medicine, Kobe University, Hyogo, Japan; Division of Gastroenterology and Hepatobiliary and Pancreatic Diseases, Department of Internal Medicine, Hyogo Medical University, Hyogo, Japan.
¹⁴ Department of Gastroenterology and Hepatology, Hokkaido University Hospital, Hokkaido, Japan.
¹⁵ Department of Gastroenterology and Hepatology, Saitama Medical Center, Saitama Medical University, Saitama, Japan.
¹⁶ Endoscopy Center, Osaka Medical and Pharmaceutical University Hospital, Osaka, Japan.
¹⁷ Second Department of Internal Medicine, School of Medicine, Wakayama Medical University, Wakayama, Japan.
¹⁸ Third Department of Internal Medicine, University of Toyama, Toyama, Japan.

PMID: 37709151
DOI: 10.1016/j.gie.2023.09.001

Abstract

Background and aims: We compared ERCP using a balloon-assisted endoscope (BE-ERCP) with EUS-guided antegrade treatment (EUS-AG) for removal of common bile duct (CBD) stones in patients with Roux-en-Y (R-Y) gastrectomy.

Methods: Consecutive patients who had previous R-Y gastrectomy undergoing BE-ERCP or EUS-AG for CBD stones in 16 centers were retrospectively analyzed.

Results: BE-ERCP and EUS-AG were performed in 588 and 59 patients, respectively. Baseline characteristics were similar, except for CBD diameter and angle. The technical success rate was 83.7% versus 83.1% (P = .956), complete stone removal rate was 78.1% versus 67.8% (P = .102), and early adverse event rate was 10.2% versus 18.6% (P = .076) in BE-ERCP and EUS-AG, respectively. The mean number of endoscopic sessions was smaller in BE-ERCP (1.5 ± .8 vs 1.9 ± 1.0 sessions, P = .01), whereas the median total treatment time was longer (90 vs 61.5 minutes, P = .001). Among patients with biliary access, the complete stone removal rate was significantly higher in BE-ERCP (93.3% vs 81.6%, P = .009). Negative predictive factors were CBD diameter ≥15 mm (odds ratio [OR], .41) and an angle of CBD <90 degrees (OR, .39) in BE-ERCP and a stone size ≥10 mm (OR, .07) and an angle of CBD <90 degrees (OR, .07) in EUS-AG. The 1-year recurrence rate was 8.3% in both groups.

Conclusions: Effectiveness and safety of BE-ERCP and EUS-AG were comparable in CBD stone removal for patients after R-Y gastrectomy, but complete stone removal after technical success was superior in BE-ERCP.

MeSH terms

Cholangiopancreatography, Endoscopic Retrograde* / adverse effects
Common Bile Duct
Endoscopes
Gallstones* / diagnostic imaging
Gallstones* / surgery
Gastrectomy
Humans
Retrospective Studies
Treatment Outcome