ERBD IN A PATIENT WITH BILLROTH II PARTIAL GASTRECTOMY

Abstract

In patients with Billroth II partial gastrectomy, it is often difficult to pass a fiberscope along the afferent loop. Once the papilla Vater can be seen by an endoscope passing through the afferent loop, ERCP is feasible. However, it is difficult to perform EPT because of reverse approach. We succeeded to perform EPT and ERBD in a patient undergone Billroth II partial gastrectomy, who had an extrahepatic bile duct stenosis due to metastasis of epipharygeal cancer. The method is as follows ; firstly, selective ERC and EN BD with a 7 Fr. pig tail catheter was performed using a forward-viewing fiberscope (Olympus GIF-HM). Secondly, a sideviewing fiberscope (J. F-3.7) was introduced into the papilla Vater over the ENBD catheter, and the ENBD catheter was withdrawn leaving the guide wire placed in the intrahepatic bile duct. Thirdly, after a 6 Fr. guide catheter was introduced into the right intrahepatic bile duct over the guide wire, 10 Fr. large bore tube could be placed correctly in the aimed position over the guide catheter through an intact papilla. And then EPT could be performed using a snare for endoscopic polypectomy as a needle knife to prevent the development of satillite pancreatitis and also to facilitate exchanging the endoprosthesis. Our experience in this case indicates that EPT and ERBD can be performed easily and safely by the above-described methods in patients with bile duct diseases after Billroth II partial gastrectomy, if a fiberscope can be entered into the region of the papilla Vater along the afferent loop.