ERCP in Billroth II gastrectomy patients

Headshot_Park_SongTae Young Park, MD¹ and Tae Jun Song, MD, PhD² report their study “Outcomes of ERCP in Billroth II gastrectomy patients.”

We investigated the outcomes and risk factors for adverse events for endoscopic retrograde cholangiopancreatography (ERCP) using a cap-fitted forward-viewing endoscope with endoscopic papillary balloon dilation (EPBD) in Billroth II gastrectomy patients.

ERCP is difficult in patients who have undergone a Billroth II gastrectomy due to the surgical alteration of the stomach and small bowel anatomy. ERCP failure in those patients is associated with difficulties in selective entrance to the afferent loop, identification of the papilla (particularly in long afferent loops), cannulation of the bile duct from an inverted position, and performance of sphincterotomy in the optimal direction. There have been small scale studies to date of ERCP using the cap-fitted forward-viewing endoscope. We therefore performed present study to evaluate the success rate, and adverse events and their risk factors, associated with ERCP using the cap-fitted forward-viewing endoscope with EPBD in Billroth II gastrectomy patients.


Figure 2. Papillary balloon dilation was performed using a balloon dilator. A, Endoscopic view. B, Fluoroscopic view.

A total of 165 patients were included. ERCP was technically successful in 144 of these cases (87.3%) and clinically successful in 141 patients (85.5%). Adverse events occurred in 38 patients (23.0%): perforation in 3 cases (1.8%), pancreatitis in 13 cases (7.9%). In multivariate analysis, ≥2 ERCP sessions (odds ratio 4.762, 95% confidence interval 1.472–15.402, P=.009) and a CBD stone size ≥ 12 mm (odds ratio 3.213, 95% confidence interval 1.140–9.057, P=.027) were significant risk factor for ERCP-related adverse events. Therefore, ERCP using a cap-fitted forward-viewing endoscope with EPBD is feasible in Billroth II gastrectomy patients. Attention should be paid to the occurrence of ERCP-related adverse events in patients who require multiple ERCP sessions or are being treated for large CBD stones.

¹Department of Internal Medicine, Hallym University College of Medicine, Chuncheon Sacred Heart Hospital, Chuncheon, South Korea
²Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea

Read the abstract for this article here.

The information presented in Endoscopedia reflects the opinions of the authors and does not represent the position of the American Society for Gastrointestinal Endoscopy (ASGE). ASGE expressly disclaims any warranties or guarantees, expressed or implied, and is not liable for damages of any kind in connection with the material, information, or procedures set forth.

One thought on “ERCP in Billroth II gastrectomy patients

  1. Fauze

    Dear Drs. Young and Song,
    Congratulation on your recent publication in GIE.
    In your opinion, what is the technical advantage to use a cap during the procedure?
    You reported 3 cases of perforation. Were these related to sphincterotomy-precut-sphincteroplasty or to damage of the afferent limb?
    Thank you,
    Fauze Maluf-Filho

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