Small-bowel perforations related to endoscopic retrograde cholangiopancreatography (ERCP) in patients with Billroth II gastrectomy

Citation
Jmv. Faylona et al., Small-bowel perforations related to endoscopic retrograde cholangiopancreatography (ERCP) in patients with Billroth II gastrectomy, ENDOSCOPY, 31(7), 1999, pp. 546-549
Citations number
17
Categorie Soggetti
Surgery,"Medical Research Diagnosis & Treatment
Journal title
ENDOSCOPY
ISSN journal
0013726X → ACNP
Volume
31
Issue
7
Year of publication
1999
Pages
546 - 549
Database
ISI
SICI code
0013-726X(199909)31:7<546:SPRTER>2.0.ZU;2-J
Abstract
Background and Study Aims: Endoscopic retrograde cholangiopancreatography ( ERCP) is one of the mainstays in the diagnosis and treatment of hepatobilia ry and pancreatic diseases, and is also increasingly used for patients with previous Billroth II gastrectomy. The aim of this study was to review our experience of ERCP in patients with Billroth II gastrectomy, and the compli cations associated with this procedure. Patients anti Methods: The records of 110 patients with Billroth II gastrec tomy, treated between January 1993 and December 1997, were received retrosp ectively. Details noted included indications for ERCP, therapeutic interven tions, causes of failure, and complications. Results: A total of 110 patients underwent ERCP; the total number of ERCP a ttempts was 185. The major indications for ERCP were cholangitis (31%), com mon bile duct stones (22%), and jaundice (15%). The endoscope was successfu lly passed up to the papilla in 134 exminations (71%), and selective cannul ation was successful in 122 of these (66%). There were 63 (34%) failed ERCP attempts. Causes of failure were: difficulty in entering the afferent loop (n = 19, 10%), failure to enter the duodenum (n = 23, 12%), endoscope-rela ted bowel perforation (n = 9, 5%), and failed cannulation (=10, 6%). The ot her two failures were caused by desaturation in the patient, and inability to distend the duodenum. The major complication of the procedure was perfor ation, which occurred in 11 examinations (6%). Of these perforations, nine occurred in the small bowel while the endoscope was being manipulated throu gh the afferent loop; these patients required laparotomy. Two patients had retroduodenal perforations, one occurring after sphincterotomy and one afte r cannulation. Both patients were successfully managed conservatively. Thre e patients suffered bleeding after sphincterotomy (3/185 procedures, 1.6%), and one patient developed acute pancreatitis. These were managed conservat ively. The overall complication rate was 8%. There were two deaths among th e patients with small-bowel perforations, and consequently an overall morta lity rate of 1% (2/185 procedures). Conclusions: Most complications of ERCP in patients with previous Billroth II gastrectomy were caused by bowel perforation while the endoscope was bei ng manipulated through the afferent limb. Such perforations are intraperito neal and require surgical intervention.