Endoscopic retrograde cholangiopancreatography in patients with pancreaticoduodenectomy with and without the use of a rigidizing overtube

Background: Surgically altered anatomy remains a challenge when performing advanced endoscopic procedures, including endoscopic retrograde cholangiopancreatography (ERCP). While ERCP maintains a success rate of 90% to 95% in patients with native anatomy, the data are less robust for patients with post-pancreaticoduodenectomy (PD) anatomy. We conducted a retrospective analysis of the technical success (TS) and clinical success (CS) rates of ERCP in post-PD patients. In addition, we describe our experience using novel rigidizing overtubes to facilitate post-PD ERCP. Methods: Patients with PD referred to our institution between 2006 and 2021 for ERCP were included. Major outcomes included the TS rate (successful biliary intervention) and the CS rate (improvement in patient symptomatology with or without normalization of bilirubin levels). Results: In total, 47 patients underwent 102 ERCPs for biliary (n = 98) and pancreatic (n = 4) indications. The overall TS and CS rates were 82.4% and 75.5%, respectively. Rigidizing overtubes were utilized in 5 patients who underwent 11 ERCPs, with TS and CS rates of 90.9% and 90.9%, respectively. The overall adverse event rate was 4.9%, with no adverse events noted in cases with rigidizing overtubes. Conclusion: Despite the challenges in ERCP in patients with surgically altered anatomy, this retrospective analysis demonstrates a moderately high TS rate with minimal adverse events. A rigidizing overtube may be utilized to improve TS and CS in patients with post-surgical anatomy.