Endoscopic retrograde cholangiopancreatography in Billroth II gastrectomy patients: Outcomes and potential factors affecting technical failure

Comparison between Enteroscopy-, Laparoscopy- and Endoscopic Ultrasound-Assisted Endoscopic Retrograde Cholangio-Pancreatography in Patients with Surgically Altered Anatomy: A Systematic Review and Meta-Analysis

“…There is a broad range of surgical interventions on the upper gastrointestinal tract that can influence ERCP success. Cases with Billroth I gastrectomy are currently uncommon, and usually do not impact the ERCP process [ 6 , 7 ] On the other hand, ERCP in patients with previous Billroth II surgery can present difficulty considering the recognition and intubation of the afferent loop with a duodenoscope and the reverse axis of common bile duct (CBD) cannulation and sphincterotomy [ 8 , 9 , 10 ]. This complexity increases when gastrectomy is combined with Roux-n-Y (RY) anastomosis, where the length of the roux limb adds a barrier to approach the biliopancreatic limb and ampulla using a duodenoscope [ 11 , 12 , 13 ] Moreover, this anatomical modification represents the vast majority of SAA cases, as it has been adopted to accompany bariatric interventions, and specifically Roux-n-Y gastric bypass (RYGB).…”

“…Currently, there is no definite recommendation regarding successful ERCP in patients with SAA. Conventional endoscopes, namely duodenoscopes, gastroscopes and colonoscopes have been proven suboptimal for ductal cannulation, particularly due to their inability to reach the ampulla or the anastomosis [ 10 , 15 , 16 ] More specifically, the conventional side-viewing duodenoscope, although represents an acceptable choice after Billroth II gastrectomies (62.5%- 86.1%), the success rate in approaching the ampulla reduces dramatically after more complex surgeries, such as RY (75.3%) or Whipple (57.9%) [ 15 , 17 ]. Further modifications, including the use of attachments, guidewires, dilatation balloons, or fluoroscopy guidance have provided positive outcomes in isolated cases, but remain inferior to advanced endoscopic techniques [ 9 , 18 , 19 , 20 ].…”

Which scope is appropriate for endoscopic retrograde cholangiopancreatography after Billroth II reconstruction: An esophagogastroduodenoscope or a colonoscope?

“…However, it is difficult to insert the side-viewing endoscope into the afferent loop, and the risk of bowel perforation was reported to be greater for ERCP in B-II patients when a side-viewing endoscope was used than when a forward-viewing endoscope was used[ 20 ]. Therefore, a forward-viewing endoscope has recently been used for this procedure and has been shown to be as effective as a side-viewing endoscope for ERCP in B-II patients[ 20 - 22 ].…”