ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY AND NEEDLE-KNIFE SPHINCTEROTOMY IN PATIENTS WITH BILLROTH-II GASTRECTOMY - A COMPARATIVE-STUDY OF THE FORWARD-VIEWING ENDOSCOPE AND THE SIDE-VIEWING DUODENOSCOPE

Background and Study Aims: A prospective, randomized study was carried out to compare the success and complication rates associated with the forward-viewing endoscope and side-viewing duodenoscope in conducting endoscopic retrograde cholangiopancreatography (ERCP) and needle-knif e sphincterotomy in patients with a Billroth II gastrectomy. Patients and Methods: The study included 45 patients with a Billroth II gastrec tomy who required ERCP and endoscopic sphincterotomy (EST) for evaluat ion and management of pancreaticobiliary disease. The patients were ra ndomly assigned to receive ERCP and EST with either a forward-viewing endoscope or a side-viewing duodenoscope. Results: Cannulation of the papilla was successful in 68% (15 of 22) in the side-viewing duodenosc ope group, and in 87% (20 of 23) in the forward-viewing endoscope grou p. Failures of cannulation occurred in seven patients in the side-view ing duodenoscope group, caused by jejunal perforation during insertion (n = 4), by a long afferent loop (n = 1), by a complaint of severe ab dominal pain (n = 1), and by failure to enter the afferent loop (n = 1 ). In the forward-viewing endoscope group, failure occurred in three p atients due to the long afferent loop (n = 2) and to an inability to c annulate despite identification of the papilla (n = 1). Sphincterotomy was successfully completed in eight of ten patients (80%) in the side -viewing duodenoscope group, and in ten of twelve patients (83%) in th e forward-viewing endoscope group. Conclusions: For ERCP and EST in pa tients with Billroth II gastrectomy, the forward-viewing endoscope is as effective as the side-viewing duodenoscope, but it may be the safer of the two instruments. The forward-viewing endoscope can be recommen ded for ERCP and EST in patients with a Billroth II gastrectomy.