Motorized spiral enteroscopy assisted endoscopic retrograde cholangiography in patients with Roux-en-Y-anatomy

In postsurgical upper gastrointestinal anatomy, motorized spiral enteroscopy (MSE) assisted endoscopic retrograde cholangiopancreaticography (ERCP) was shown feasible and has the advantage that standard ERCP instruments can be used. Therefore, MSE-ERCP appears to be the optimal solution for postsurgical patients, especially with Roux-en-Y anatomy.

To show feasibility and safety of MSE-ERCP in patients with Roux-en-Y anatomy.

We retrospectively analyzed all consecutive MSE-ERCP procedures in patients with Roux-en-Y anatomy between September 2021 and May 2023 in an endoscopic tertiary referral center.

We identified 26 MSE-ERCPs: (1) 18 MSE-ERCPs in 13 patients with Roux-en-Y anatomy after liver transplantation (n = 11) or gastrectomy (n = 2); and (2) Another 8 MSE-ERCP interventions in 5 patients with very long Roux-en-Y situation after gastric bypass. Overall success of reaching the biliary entry was 88% and further interventions were successful in 83% of patients. In very long alimentary limb situations, success of reaching the biliary entry was not-significantly lower compared to "standard" Roux-en-Y (75% vs 94%, P = 0.215). ERCP-interventions were not-significantly less successful in patients with native papilla compared to hepaticojejunostomy (63% vs 93%, P = 0.103). Mean intervention time was 105 minutes. Intervention times were longer in very long limb situations (133 minutes vs 91 minutes; P = 0.032). Overall, we observed three adverse events (n = 1 caused by enteroscopy, n = 1 caused by the biliary intervention, n = 1 unrelated to the procedure). In 15/26 cases (58%) MSE-ERCP was carried out on an outpatient basis.

MSE-ERCP has been a promising technique for patients with Roux-en-Y reconstruction requiring biliary interventions. However, MSE was recently withdrawn from the market due to severe safety concerns, which were not observed in this study.