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ERCP in post-Billroth II gastrectomy patients: emphasis on technique
1Department of Internal Medicine, Shalu Tungs Memorial Hospital, Taichung, Taiwan, ROC.
The American Journal of Gastroenterology
|February 6, 1999
Summary
Endoscopic retrograde cholangiopancreatography (ERCP) after Billroth II gastrectomy has a 62.5% success rate. Special techniques improve afferent loop access and cannulation success in these challenging cases.
Area of Science:
- Gastroenterology
- Endoscopy
- Surgical Anatomy
Background:
- Billroth II (BII) gastrectomy alters anatomy, complicating endoscopic retrograde cholangiopancreatography (ERCP).
- Challenges include accessing the afferent loop and selective cannulation of biliary and pancreatic ducts.
Purpose of the Study:
- To evaluate the success rate of ERCP in post-Billroth II gastrectomy patients.
- To report special manipulations and techniques used to overcome anatomical challenges.
Main Methods:
- Retrospective review of 56 ERCP procedures in post-BII gastrectomy patients.
- Utilized forward-viewing and side-view endoscopes, with specific techniques for afferent loop entry (e.g., using different orifices, fluoroscopy, hand compression, snare).
- Employed specialized catheter and guidewire techniques for common bile duct cannulation.
Main Results:
- Successful afferent loop entrance was achieved in 76.7% of cases.
- ERCP cannulation success rate was 81.3% in patients with successful afferent loop intubation.
- Overall ERCP success rate was 62.5%, with no serious complications reported.
Conclusions:
- ERCP in post-BII gastrectomy patients is feasible with a 62.5% success rate.
- Specific endoscopic manipulations and techniques significantly aid in achieving successful outcomes.