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

Background: 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.

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

Methods: 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.

Results: 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.

Conclusion: 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 However, MSE was recently withdrawn from the market due to severe safety concerns, which were not observed in this study.