Needle-knife sphincterotomy guided by a biliary endoprosthesis in Billroth II gastrectomy patients

All available techniques for performing endoscopic sphincterotomy in Billroth II gastrectomy patients have their limitations, and no standard technique has emerged. A new technique, needle-knife sphincterotomy guided by a thin (7 Fr) biliary endoprosthesis, is described here that overcomes some of the limitations of other techniques.

The technique was attempted in 19 nonselected patients during a three-year period. The results were retrospectively assessed. The outcome variables were the achievement of an adequate sphincterotomy and complications.

An adequate sphincterotomy could be performed without much technical difficulty in 18 of the 19 patients. There was one complication, a retroperitoneal leakage, that settled with conservative treatment.

In patients with Billroth II anastomoses, endoprosthesis-guided sphincterotomy is a new and relatively easy procedure, which is especially attractive once selective bile duct cannulation has been achieved. This technique allows the performance of sphincterotomy as a well-controlled procedure, and may, therefore, be safer than nonguided techniques. In contrast to previously reported guided techniques using nasobiliary cannulas, the endoprosthesis technique does not necessitate withdrawing and reinserting the endoscope.