Is ERCP a Reasonable Diagnostic Method for Excluding Pancreatic and Hepatobiliary Disease in Patients with a Billroth II Resection?

Abstract

ERCP was performed in 57 patients who had undergone Billroth II resection. Cannulation of the papilla of Vater was successfully accomplished in 31 cases (55%). The success rate of ERCP was clearly dependent on the type of Billroth II resection presenting.

Oblique‐viewing Endoscope Facilitates Endoscopic Retrograde Cholangiopancreatography and Associated Procedures in Post‐billroth Ii Gastrectomy Patients

“…The type of endoscopy is responsible for the type of problem. Generally, ERCP in patients with Billroth II gastrectomy has been performed with a side‐ 2–10 or a forward‐viewing endoscope 11–13 with the former being preferred. The side‐viewing endoscope permits one to reach the papilla of Vater as if in patients with a long afferent loop because of the rigidity and long working length 2–4 .…”

“…Generally, ERCP in patients with Billroth II gastrectomy has been performed with a side‐ 2–10 or a forward‐viewing endoscope 11–13 with the former being preferred. The side‐viewing endoscope permits one to reach the papilla of Vater as if in patients with a long afferent loop because of the rigidity and long working length 2–4 . But the fact that it is impossible to see the lumen en face makes it difficult to enter the afferent loop 2,4–6,12 and to locate the optimal position to cannulate the papilla 5,7 .…”

“…However, difficulties are encountered in entering the afferent loop and cannulating the papilla of Vater with either type. Success rates have been reported to range from 46% to 92% 2–13 …”

“…Although Billroth II gastrectomy is now uncommon, it is not rare to see patients with this type of reconstruction referred for ERCP or associated procedures because they have a higher-than-normal incidence of biliary disorders, such as cholelithiasis. 1 To perform ERCP or endoscopic sphincterotomy (EST) in such patients, some endoscopists have chosen a side-viewing endoscope [2][3][4][5][6][7][8][9][10] and others a forward-viewing endoscope. [11][12][13] However, difficulties are encountered in entering the afferent loop and cannulating the papilla of Vater with either type.…”

Therapeutic endoscopic retrograde cholangiopancreatography using an anterior oblique-viewing endoscope for bile duct stones in patients with prior Billroth II gastrectomy

“…The factors that preclude insertion of the scope into the descending portion of the duodenum in B-II gastrectomy cases include a long afferent loop, sharp angulation of the anastomosis between the afferent loop and the gastric remnant, and the presence of a Braun anastomosis. 2,16 To overcome diffi cult intubation of the descending duodenum, the manual compression method and use of a different scope are considered effective. Several other techniques, including the use of a doubleballoon enteroscope 17,18 or an anterior-viewing endoscope with a transparent cap attached to its tip, 15,19,20 have been reported.…”