Evaluation of complications after ERCP using a short type double balloon endoscope in patients with altered gastrointestinal anatomy: a single‐center retrospective study of 1,576 procedures

BACKGROUND AND AIMS: Endoscopic retrograde cholangiopancreatography (ERCP) using balloon assisted endoscope (BAE) such as double balloon endoscope (DBE) is even effective for patients with surgically altered anatomy. Yet comprehensive studies on complications of ERCP using BAE (BAE-ERCP) have not been made. We analyzed the characteristics and the causes of complications of ERCP using DBE (DB-ERCP) procedures and aimed to suggest effective managements. METHODS: 1,576 procedures of DB-ERCP in 716 patients with surgically altered gastrointestinal anatomy in our hospital were evaluated retrospectively using a statistic analysis. RESULTS: The overall complication occurrence rate was 5.8%. By type of complications are; perforation 3.2%, mucosal laceration 0.5%, hemorrhage 1.0%, pancreatitis: 0.6%, respiratory disorder 0.4%, and others 0.2%. By type of surgical reconstruction methods were; Roux-en-Y (R-Y) reconstruction with choledocho-jejunal anastomosis (CJA) 4.2%, R-Y without CJA 6.7%, pancreaticoduodenectomy (PD) 4.5%, pylorus preserving pancreaticoduodenectomy (PpPD) 4.2%, Billroth-II gastrectomy (B-II) 11.6%, and other reconstruction method (others) 7.4%. The contributing factors calculated by a multivariate analysis were B-II (odds ratio [OR]: 1.864, 95% confidence interval [CI]: 1.001-3.471, p = 0.050), and the presence of naive papilla (OR: 3.268, 95% CI: 1.426-7.490, p = 0.005). CONCLUSIONS: DB-ERCP is a safe method with a total complication rate of 5.8% which could be considered within an acceptable range. The most common complication was the injury of the digestive tract such as perforation. Affecting risk factors for complications were B-II, and the presence of naive papilla. DB-ERCP procedures should be performed carefully of these factors.