ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY IN PATIENTS WITH BILLROTH II GASTRECTOMY

Abstract

Endoscopic retrograde cholangiopancreatography(ERCP)in patients with Billroth II (B-II) gastrectomy has a number of problems such, as intubation of the afferent loop, reaching the papilla of Vater, cannulation and endoscopic sphincterotomy(EST)from areversed position. we reviewed the records of 164 ERCPs performed in 118 consecutivepatients With B-II gastrectomy at Shinshu University Hospital and its affiliated hospitalsbetween January 1989 and December 1996. Standard or therapeutic duodenascopes wereused routinely. EST Was performed using a needle-knife guided by a bitionasal drainagecatheter or biliary endoprosthesis. Cannulation of the desired duct was achieved in 124 of 164(75.6%)ERCPs;98 of 124 (79.0%) ER s and 26 of 40 (65.0%)ERPs. Reasons far failure in FRCP included;the afferent loop was too long to reach the papilla (25), thepapilla was identified but failed cannulation(10), the papilla was not identified in spite of reaching duodenal stump(3), and the afferent loop could not be entered(2). However, irlpatients whom the papilla was seen, cannulation was successful in 98 of 107(91.6%)ERCs and 26 of 27(96.3%)ERPs. Stone was extracted successfully achieved in 27 of 40(67.5%)patients with common bile duct calculi following EST (25) or endoscopic balloon papillarydilation(2), Complications occurred in 4 patients;retroperitoneal perforation(3), andbleeding(1). All complications were recovered by conservative management. Endoscopicbiliary drainage(EBD)was successful in 10 of 16(62.5%)patients with malignant biliaryobstruction. Reasons for failure in EBD included inability to reach the papilla(3)andfailure to cannulate(3). The most common reason for failure in ERCP in patients with B-II gastrectomy was inability to reach the papilla. However, tolerable results of diagnosticand therapeutic ERCP could be obtained in patients wham the papilla of Voter wasidentified. Recently, we have used an oblique-viewing endoscope in patients with B-II anastamoses who had been suspected biliary disease. This scope is superior to duadena-scope in reaching the papilla and in bile duct cannulation.