Pancreatic endosonography after Billroth II gastrectomy

Prior Billroth II gastrectomy is considered a relative contraindication to endoscopic ultrasonography (EUS) of the pancreatic head. This study reviews experience with pancreatic EUS in such patients.

Eleven patients were identified who had previous Billroth II gastrectomy and underwent attempted pancreatic EUS.

Examination of the pancreatic head was technically feasible in 10 of the patients. The inferior pancreatic head, ampulla, and periampullary ducts were seen in all; the superior pancreatic head and porta hepatis were visualized in 50 % of cases with radial echo endoscopes and 100 % with a linear-array echo endoscope. The pancreatic neck was fully imaged in 25 % of cases with radial echo endoscopes and in 60 % with a linear-array echo endoscope. One known pancreatic neck mass was not visualized.

Pancreatic EUS is technically feasible in most patients with a prior Billroth II gastrectomy. Linear-array echo endoscopes provide a more complete examination than radial echo endoscopes. The pancreatic neck may be difficult to visualize.