Application of single balloon enteroscopy-assisted endoscopic retrograde pancreatography in patients with pancreaticojejunal anastomotic stenosis

doi:10.16139/j.1007-9610.2026.01.09

Abstract

Abstract:

Objective To evaluate the feasibility, effectiveness, and long-term outcome of single balloon enteroscopy(SBE)-assisted endoscopic retrograde pancreatography(ERP) in patients with pancreaticojejunal anastomotic stenosis (PJS). Methods The clinical data of 16 PJS cases undergoing SBE-assisted ERP from March 2016 to March 2021 were retrospectively reviewed. Technical and clinical success, adverse events, risk factors for failure and long-term outcomes were assessed. Results Eight of 16 patients were successfully treated, the success rate was 50%. No serious complications after ERP occurred. Risk factors for failure of pancreaticojejunostomy site identification included digestive tract Child reconstruction sequence (P=0.001), pancreaticojejunostomy method (P=0.001), without pancreatic duct support tube placement (P=0.037), undilated preoperative pancreatic duct (P=0.037) and postoperative pancreatic fistula (P=0.001). The interval between the first occurrence of abdominal pain after pancreaticoduodenectomy (PD) operation in the successful anastomotic site identification group was significantly longer than that in the failed group（44.7 months vs. 19.9 months, P=0.044）, while the time from symptom onset to the first ERP intervention was shorter than that in the anastomotic site identification failed group （8.4 months vs. 22.4 months, P=0.021）. During the follow-up periods [77.2(6.8, 187.7)months], recurrence rates were 25%. The total duration of stent placement in 7 patients with endoscopic pancreatic drainage treatment was 62.3 (6.8, 153.7). Body mass index (BMI) variation is +2.46 kg/m² in non-recurrence group compare to -1.09 kg/m² in recurrence group and -2.12 kg/m² in ERP treatment failure group. Conclusions SBE-assisted ERP treatment for PJS after PD showed favorable safety, effectiveness and durable long-term outcomes. ERP intervention should be carried out early once PJS occurs. BMI is an important index to be monitored during the follow-up of PJS patients.

Key words: Pancreaticoduodenectomy (PD), Pancreaticojejunostomy anastomotic stenosis (PJS), Endoscopic retrograde pancreatography (ERP), Single balloon enteroscopy (SBE)

CLC Number:

R657.5

ZHOU Xueping, WENG Hao, WENG Mingzhe, SHU Yijun, ZHAO Mingning, GU Jun, WANG Xuefeng. Application of single balloon enteroscopy-assisted endoscopic retrograde pancreatography in patients with pancreaticojejunal anastomotic stenosis[J]. Journal of Surgery Concepts & Practice, 2026, 31(01): 50-57.

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References 30

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Factors	Anastomotic site identification success(n=7)	Anastomotic site identification failure(n=7)	t value	P value
The time of first abdominal pain after the operation (month)	44.7	19.9	2.251	0.044
The time from the operation to the first ECRP treatment (month)	53.1	42.3	0.927	0.372
The time from the symptom onset to ERP treatment (month)	8.4	22.4	-2.658	0.021

Factors	Category	Anastomotic site identification success	Anastomotic site identification failure	χ² value	P value
Age (year)	<60	3	3	0.000	1.000
Age (year)	≥60	4	4	0.000	1.000
Sex	Male	4	3	0.265	0.606
Sex	Female	3	4	0.265	0.606
The primary disease (benign or malignant)	Benign	4	4	0.000	1.000
The primary disease (benign or malignant)	Malignant	3	3	0.000	1.000
Digestive tract reconstruction method	Child	7	3	5.200	0.001
Digestive tract reconstruction method	Whipple	0	4	5.200	0.001
Methods of pancreaticojejunostomy	Invagination	4	0	5.200	0.001
Methods of pancreaticojejunostomy	Duct to mucosa	3	7	5.200	0.001
Pancreatic duct dilation before PD	Yes	6	2	4.333	0.037
Pancreatic duct dilation before PD	No	1	5	4.333	0.037
Pancreatic duct tube placement during PD	Yes	6	2	4.333	0.037
Pancreatic duct tube placement during PD	No	1	5	4.333	0.037
Postoperative pancreatic fistula	Yes	1	6	6.633	0.010
Postoperative pancreatic fistula	No	6	1	6.633	0.010
Pancreatic duct dilation before ERP	Yes	3	3	0.000	1.000
Pancreatic duct dilation before ERP	No	4	4	0.000	1.000
Pancreatic duct stones	Yes	1	2	0.394	0.530
Pancreatic duct stones	No	6	5	0.394	0.530
AMY increases before ERP	Yes	5	4	0.289	0.591
AMY increases before ERP	No	2	3	0.289	0.591

Patient No.	Number of ERP treatments	Duration and course of ERP treatment	Follow-up time (month)	Relapse or not	Time of recurrence after the last ERP (month)	Stent indwelling time (month)	BMI change（kg/m²）
A	1	2018.1 5Fr dilation catheter tip dilated anastomotic site	39.0	Yes	1.0	0	-1.81
B	2	2016.8 5Fr stent was inserted after 5Fr catheter dilation	20.2	Yes	1.2	15.7（5Fr）	-0.34
B	2	2017.11 Removal of pancreatic duct stent	20.2	Yes	1.2	15.7（5Fr）	-0.34
C	2	2019.6 7Fr stent was inserted after 5Fr catheter dilation	21.8	No	/	13.3（7Fr）	+3.90
C	2	2020.7 Removal of pancreatic duct stent	21.8	No	/	13.3（7Fr）	+3.90
D	2	2019.11 4 mm cylindrical balloon dilated anastomotic site, 5Fr stent was inserted	17.7	No	/	15.0（5Fr）+2.7（7Fr）	+0.32
D	2	2021.2 4 mm cylindrical balloon dilated anastomotic site, 7Fr stent was inserted	17.7	No	/	15.0（5Fr）+2.7（7Fr）	+0.32
E	2	2020.12 Anastomotic site could not be found	2.7	No	/	2.7（7Fr）	0
E	2	2021.1 Cannulation was successful with a combination of enteroscopy and EUS-PD, 7Fr dilation catheter dilated anastomotic site, and 7Fr stent was inserted until now	2.7	No	/	2.7（7Fr）	0
F	1	2016.3 7Fr stent was inserted after 7Fr catheter dilation until now	61.5	No	/	61.5（7Fr）	+6.76
G	3	2015.2 5Fr catheter dilated anastomotic site, 5Fr stent was inserted	75.1	No	/	29.8（5Fr）+25.5（7Fr）	+2.00
		2017.8 7Fr catheter dilated anastomotic site, 7Fr stent was inserted
		2019.8 Removal of pancreatic duct stent
H	2	2020.7 6 mm cylindrical balloon dilated anastomotic site, partial stone, 5Fr stent was inserted 2021.1 6 mm cylindrical balloon dilated anastomotic site + all stones extraction, 7Fr stent was inserted until now	9.0	No	/	6.0（5Fr） +3.0（7Fr）	+1.83