ENDOSCOPIC SPHINCTEROTOMY IN PATIENTS WITHBILLROTH II GASTRECTUMY USING EILIARY DRAINAGE TUTBE

Abstract

Endoscopic sphincterotorny (EST) in patients with previous Billroth II gastrectomy isusually difficult to perform for incomplete observation of the cutting point and controlcutting direction, because of the reverse approach to the papilla. To solve these problems, we tried to place in advance the endoscopic biliary stenting (EBS) tube or the bilianasaldrainage (BND) catheter into the cornrnon bile duct a saguide for cutting the papilla withaneedle type papillotome. This allowed us easy to observe cutting, point and direction, andEST was done safely and steadily. Moreover, even in the cases whereby the insertion ofendoscope to the papilla was difficult, EST could be performed at first insertion when EBStube was used. This technique will expand the indication of E5T to patients with Billroth II gastrectomy who are regarded as technical difficult cases and kept at a distance from EST.