单气囊短小肠镜在消化道重建术后ERCP中的应用研究：一项单中心回顾性研究

Short-type single-balloon enteroscopy-assisted ERCP in patients with surgically altered anatomy: a single-center retrospective study

摘要:

目的 评估单气囊短小肠镜辅助逆行胆胰管造影术（short-type single-balloon enteroscopy assisted endoscopic retrograde cholangiopancreatography, SSBE-ERCP）在消化道重建术后胆胰疾病患者中应用的有效性和安全性，并探讨影响SSBE-ERCP成功的因素。方法：回顾性收集2018年1月至2025年7月于海军军医大学第一附属医院消化内镜中心行SSBE-ERCP患者的临床资料，分析手术成功率、临床疗效、不良事件和导致手术失败的因素。结果 共纳入213例患者（315次SSBE-ERCP）。SSBE-ERCP目标部位到达率为83.49%（263/315），胆胰管插管成功率为91.22%（239/263），SSBE-ERCP总体成功率为75.87%（239/315）；总体临床成功率为94.56%（226/239）；不良事件发生率为8.57%（27/315），以轻中度为主。多因素Logistic回归分析发现Roux-en-Y吻合术（OR=4.17，95%CI：1.68~10.33，P=0.002）、Braun吻合（OR=5.88，95%CI：2.10~1646，P=0.001）和胰腺疾病（OR=4.41，95%CI：1.77~10.99，P=0.001）是导致SSBE-ERCP失败的独立影响因素。结论 SSBE-ERCP治疗消化道重建术后胆胰疾病安全有效。Roux-en-Y吻合术、Braun吻合和胰腺疾病是导致SSBE-ERCP失败的独立影响因素。

Abstract:

Objective Short-type single-balloon enteroscopy-assisted endoscopic retrograde cholangiopancreatography (SSBE-ERCP) has been increasingly used in patients with surgically altered anatomy. However, data on its clinical outcomes and factors associated with procedural success remain limited. This study aimed to evaluate the effectiveness and safety of SSBE-ERCP in patients with biliary-pancreatic diseases after digestive tract reconstruction and to identify factors influencing procedural success. Methods A retrospective analysis was conducted on patients who underwent SSBE-ERCP at the Digestive Endoscopy Center of the First Affiliated Hospital of Naval Medical University between January 2018 and July 2025. Data on procedural success rates, clinical outcomes, adverse events, and factors contributing to procedural failure were collected and analyzed. Results A total of 213 patients undergoing 315 SSBE-ERCP procedures were included. The enteroscopy (target site reach) rate was 83.49% (263/315), the biliary-pancreatic duct cannulation rate was 91.22% (239/263), and the overall technical success rate was 75.87% (239/315). Among technically successful procedures, the overall clinical success rate was 94.56% (226/239). Adverse events occurred in 8.57% (27/315) of procedures, with the majority being mild to moderate. Multivariate logistic regression analysis identified Roux-en-Y anastomosis (OR, 4.17; 95% CI, 1.68-10.33; P=0.002), Braun anastomosis (OR, 5.88; 95% CI, 2.10-16.46; P=0.001), and pancreatic diseases (OR, 4.41; 95% CI, 1.77-10.99; P=0.001) as independent factors associated with procedural failure. Conclusion SSBE-ERCP is effective and safe for the management of biliary-pancreatic diseases in patients with surgically altered anatomy. Roux-en-Y anastomosis, Braun anastomosis, and pancreatic diseases are independent predictors of procedural failure.