Objective

Endoscopic retrograde cholangiopancreatography (ERCP) in patients with Roux-en-Y (RY) reconstruction after total gastrectomy is difficult to be performed with routine instruments. The primary aim of this study was to analyze the feasibility and safety of cap-assisted routine adult colonoscope (CARAC) for ERCP in such patients.

Methods

We identified 16 consecutive patients with indications of ERCP, who had previously undergone total gastrectomy with RY reconstruction at two tertiary care endoscopy centers. All ERCP procedures were carried out with CARAC. Success rate of achieving the papilla, biliary cannulation and procedure-related adverse events were analyzed.

Results

The papilla was successful achieved in 11 of 16 (68.8%) cases, and biliary access was subsequently achieved in 8 of 11 (72.7%) cases. Three patients acquired success by percutaneous-endoscopic rendezvous after failed cannulation. The overall clinical success was achieved in 11 of 16 (68.8%) patients. Procedure-related mild acute pancreatitis were found in 4/16 (25%) cases and mild cholangitis in 3/16 (18.8%) cases. There were no serious adverse events such as perforation or bleeding occurred in all patients.

Conclusions

Cap-assisted routine adult colonoscope for therapeutic ERCP is safe and effective in patients after total gastrectomy with Roux-en-Y reconstruction.

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