1Division of Gastroenterology, Department of Internal Medicine, Dankuk University, College of Medicine, Chunan, South Korea 2Department of General Surgery, Dankuk University, College of Medicine, Chunan, South Korea
Corresponding author:
Im Hwan Roe,
ABSTRACT
Background/Aim: Endoscopic retrograde cholangiopancreatography(ERCP) procedures are more difficult in patients who have undergone Billroth II gastrectomy. We reviewed our results of ERCP and sphincterotomy in patients with Billroth II anastomosis. Method: 32 attempts of ERCP have been performed in 24 patients with Billroth II gastrectomy between June, 1994 and July 1996. Side viewing duodenoscopes were used initially in every cases and forward viewing endoscopes were used subsequently in a few patients who had difficulty. Results: We obtained full diagnostic information in 78.1%(25/32 cases), and 7 cases were failed in cannulation(21.9%) due to 6 cases with Braun anastomosis(85.7%) and 1 case with severe distorted position of papilla.. Endoscopic sphincterotomy (EST) was performed in 14 cases using the needle knife papillotome(N=6) and Soehendra Billroth II papillotome(N=8) respectively. We thought Soehendra papillotome was better than the needle knife papillotome because an adequate and complete sphincterotomy was achieved at first attempt by Soehendra papillotome. We had complications in 2 patients(6.2%). One of them revealed retroperitoneal perforation which was successfully terated with antibiotic therapy. Conclusion: Major cause of ERCP failure was anatomical alteration related to previous surgry such as Braun’s anastomosis. Because EST in patients with Billroth II gastrectomy is likely to carry a high risk for perforation, more novel technique and specially designed sphincterotomes will be needed to achieve the safer and more effective therapeutic ERCP procedures.
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