Endoscopic Retrograde Cholangiopancreatography Using a Multi-bending Duodenoscope in Patients with a Billroth I Gastrectomy

Abstract

Aims : We assessed the success rate at our endoscopic center in patients with a Billroth I gastrectomy and compared it to the rate in patients without a gastrectomy, retrospectively, and assessed the clinical utility of a multi-bending duodenoscope for bile duct cannulation in patients with a Billroth I gastrectomy.
Patients and Methods : Six-hundred and twenty patients who underwent endoscopic retrograde cholangiopancreatography (ERCP) with the use of a conventional single-bending duodenoscope and 26 patients who underwent ERCP with a multi-bending duodenoscope were enrolled. Of the 620 patients, 560 had no history of gastrectomy and the remaining 60 had had a Billroth I gastrectomy. The latter 26 patients included six patients whose bile duct cannulation was unsuccessful by conventional endoscope (three of whom were without gastrectomy and the other three had had a Billroth I gastrectomy).
Results : The success rate of bile duct cannulation in the patients who underwent ERCP with the conventional duodenoscope was higher in those without gastrectomy (89%) than in those with a Billroth I gastrectomy (85%), but the difference was not significant. Bile duct cannulation was successful with the multi-bending duodenoscope in all three patients with a Billroth I gastrectomy whose previous cannulation by conventional endoscopy was unsuccessful. In contrast, the cannulation was not successful in all three patients without gastrectomy whose previous cannulation was unsuccessful by conventional endoscopy. The success rate in the 20 naive patients without gastrectomy was 95% by multi-bending duodenoscope. The incidence of post-ERCP pancreatitis was similar between the patients with the use of the single- (7.6%) and multi-bending (7.7%) duodenoscopes.
Conclusion : Our preliminary data suggest that the success rate of bile duct cannulation in the patients who underwent ERCP with the single-bending duodenoscope (TJF-260V) was higher in those without gastrectomy (89%) than in those with a Billroth I gastrectomy and a multi-bending duodenoscope might be beneficial for bile duct cannulation in patients with a Billroth I gastrectomy.