ERCP in post-Billroth II gastrectomy patients: Emphasis on technique

Objective: Endoscopic retrograde cholangiopancreatography (ERCP) in post-Bi llroth LI (BH) gastrectomy is more difficult due to anatomical changes. The difficulties include entrance to the afferent loop and selective cannulati on, Our aim here is to report the success rate and special manipulations an d techniques of this procedure, Methods: A retrospective review of 56 ERCP procedures in post-BII gastrectomy patients was performed. There were 43 ma le and 13 female patients with a mean age of 63 yr (range, 32-78 ST). All c ases were tried with forward-viewing endoscope first. Of the failed cases, 10 were retried by side-view duodenoscope, The entrance to the afferent loo p was attempted by starting from the upper opening at the anastomosis site and, if this failed, then using the lower opening; presence of bile; and ai r-contrasted afferent loop under fluoroscopy, If failure of afferent loop e ntrance resulted, hand compression over the mid-abdomen, or polypectomy sna re in the working channel of the endoscope, was tried, For failure of commo n bile duct cannulation with straight catheters, techniques of pushing the catheter against the duodenal wall and bending the tip of the endoscope or guidewire were used. Results: The success rate of afferent loop entrance wa s 76.7% (43 of 56 cases). The afferent loop was identified in the upper ori fice of the anastomosis in 93% (40 of 43) of the cases, Eight cases of affe rent loop entrance could be facilitated by hand compression, and three by p olypectomy snare in the working channel of the endoscope, The success rate of ERCP cannulation in those successful afferent loop intubation cases was 81.3% (35/43 cases). Most of the selective common bile duct (CBD) cannulati on was achieved by straight (new) catheter and an additional six cases were successful using the techniques mentioned. No serious complications were e ncountered, except three cases of submucosal hemorrhage. Conclusion: The ov erall success rate of BII ERCP was 62.5% (35 of 56 cases), The special mani pulations mentioned in BII ERCP can be helpful in certain cases. (C) 1999 b y Am, Cell. of Gastroenterology.