Re. Hintze et al., ENDOSCOPIC SPHINCTEROTOMY USING AN S-SHAPED SPHINCTEROTOME IN PATIENTS WITH A BILLROTH-II OR ROUX-EN-Y GASTROJEJUNOSTOMY, Endoscopy, 29(2), 1997, pp. 74-78
Background and Study Aims: Some patients admitted for endoscopy presen
t a gastrojejunostomy with a Billroth II anastomosis or Roux-en-Y reco
nstruction. The gastrointestinal reconstruction hampers endoscopic dia
gnosis and treatment of the biliary and pancreatic tract. The present
paper describes a new procedure facilitating endoscopic retrograde cho
langiopancreatography (ERCP) in patients who have undergone gastrojeju
nostomy. Patients and Methods: ERCP was attempted in 65 patients with
gastrojejunostomy. A conventional side-viewing endoscope was advanced
into the duodenal stump, and a modified catheter was pushed through th
e endoscope. The cutting wire of the modified catheter winds round the
catheter at a pivotal point between the catheter's proximal and dista
l holes. This allows the catheter tip to be forced into an S-shape whe
n the wire is pulled. Since the cutting wire can easily be adjusted to
the papillary roof, safe and successful endoscopic sphincterotomy can
be carried out. Results: We were able to advance the conventional sid
e-viewing endoscope into the duodenal stump in 92% of the patients (n
= 59) with Billroth II gastrojejunostomies, and in 33% of the patients
(n = 6) with Roux-en-Y anastomoses. Whenever it was possible to reach
the duodenal stump, cannulation and sphincterotomy of the papilla of
Vater was successful. Ninety-six percent of the patients who underwent
sphincterotomy (n = 54) immediately benefited from biliary decompress
ion. One major complication occurred, with a patient suffering a retro
peritoneal perforation during endoscopic sphincterotomy; the patient l
ater died, despite three subsequent surgical operations. Conclusions:
In spite of previous gastrojejunostomy, most patients with Billroth II
anastomoses (92%) and many patients with Roux-en-Y reconstructions (3
3%) can be treated endoscopically for biliary diseases. The use of a c
onventional side-viewing endoscope in conjunction with an S-shaped sph
incterotome can be recommended. This allows safe and successful endosc
opic treatment of all patients in whom endoscopic access to the papill
a of Vater is possible.