Effect of pouched reconstruction after total gastrectomy on ERCP and ENBD--report of two cases

Endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic nasobiliary drainage (ENBD) are well known to be useful but these procedures are rarely indicated in patients after total gastrectomy, because the endoscopic approach is more difficult in the patients with standard reconstructions such as Roux-en-y esophagojejunostomy after total gastrectomy. Gastric replacement with various enteric reservoirs after gastrectomy has been used to improve the postprandial symptoms and nutrition of patients after total gastrectomy. We have been performing jejunal pouch double tract reconstruction (JPD) after gastrectomy and the patients' postoperative course has been satisfactory. In this report, we describe two cases of biliary tract disorders after total gastrectomy. One was choledocholithiasis and the other was bile leakage after cholecystectomy. In each case, we performed ERCP, and treated with ENBD tube placement, and we obtained satisfactory results. We emphasize that ERCP and ENBD are also useful and easy procedures for biliary tract disease in postgastrectomy patients with JPD reconstruction as well as in patients who have not undergone intestinal reconstruction. The advantages of JPD reconstruction are not only improving the postprandial symptoms and the nutrition of patients after total gastrectomy, but that it provides an easy endoscopic approach to the papilla of Vater.