Endoscopic retrograde cholangiopancreatography (ERCP) and sphincterotomy (EST) after BII resection

We analysed the results of 437 endoscopic retrograde cholangiopancreatographies (ERCP) and 126 endoscopic sphincterotomies (EST) after gastric diversion surgery collected from the literature and from our hospital. The most difficult step in the procedure was duodenal intubation (90% success; range 33-95%). This greatly depended on the method of intestinal reconstruction. Poorest results were related to a long jejunal loop with entero-enterostomy (Braun's anastomosis). A final ERCP success rate was 74% (46-95%). EST could be performed in most of the cases (93%) indicated. Extraction of biliary calculi succeeded only infrequently. Insertion of biliary stents was possible. Special techniques of the procedure are discussed. It is concluded that ERCP and EST may also be performed after gastric surgery with varying success depending on the method of intestinal reconstruction. Both doctor and patient should be prepared to the possible use of alternative methods.