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

Abstract

Background : Endoscopic retrograde cholangiopancreatography (ERCP) and associated procedures have been reported to be difficult to perform in patients with Billroth II gastrectomy. We evaluated the feasibility of using an oblique-viewing endoscope equipped with a cannula deflector for these procedures in such patients. Patients and Methods : Twenty-four patients with Billroth II gastrectomy were enrolled in the present study and underwent ERCP, endoscopic sphincterotomy, endoscopic nasobiliary drainage, expandable metal stent placement or tube stent placement. All procedures were performed with an oblique-viewing endoscope equipped with a cannula deflector. Results : In all patients, afferent loops were entered. Reaching the papilla of Vater was achieved in 22 (91.7%) patients, in whom all planned procedures were accomplished. One patient experienced acute pancreatitis, hemorrhage from the papilla of Vater after sphincterotomy, and intestinal perforation. Conclusions : We believe an oblique-viewing endoscope equipped with a cannula deflector to be useful in performing ERCP and associated procedures in many patients with Billroth II gastrectomy. However, one should be aware of major complications, such as perforation, that may occur.

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

“…We achieved a high success rate of cannulation of the bile duct by using an anterior oblique-viewing endoscope. Kikuyama et al 3 reported the results of the use of an anterior oblique-viewing endoscope in ERCP and associated procedures in cases with B-II gastrectomy. They succeeded in reaching the papilla in 22 of 24 cases (91.7%) with the scope, and cannulation of the bile duct was successful in all 22 cases.…”

“…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. Only one study discusses the efficacy of an anterior oblique-viewing endoscope in ERCP and associated procedures in patients with B-II gastrectomy, 3 and its effi cacy and safety have not yet been clarifi ed.…”

“…1,2 The number of reports is limited, however, and the procedure has not yet been well established. Kikuyama et al 3 has already reported the utility of an anterior oblique-viewing endoscope in endoscopic retrograde cholangiopancreatography (ERCP) and associated procedures, and problems with its use, in cases with B-II gastrectomy. They reported that the endoscope provides good visibility for entering the afferent loop and makes possible a good selective cannulation success rate, although from the reverse position.…”

Utility of endoscopic retrograde cholangiopancreatography on biliopancreatic diseases in patients with Billroth II-reconstructed stomach

“…In the patients for whom the fiber reached the papilla in this study, the success rate of cannulation was as high as 90.9%. This report does not have inferiority in comparison with the results of an anterograde oblique-viewing endoscope[21,22]. The reason why the success rate was high despite that this patient represented a case with difficulty in cannulation, in which the papilla existed on the opposite side from the usual one, was because the flexible tip catheter[23], etc ., with which the angle can be changed in cannulation, was used.…”

Therapeutic endoscopy for stenotic pancreatodigestive tract anastomosis after pancreatoduodenectomy (with videos)

“…However, with a forward-viewing endoscope, identifying the anastomosis and cannulating the main pancreatic duct via the anastomosis were difficult because of the sharp angulation required to observe the intestinal wall and the lack of a cannula deflector. 8 Under these considerations, an oblique-viewing endoscope that facilitates ERCP in Billroth II 13,14 or Roux-en-Y reconstruction 15 is considered ideal to cannulate the main pancreatic duct via the stenotic pancreatojejunostomy because it has a cannula deflector with good visibility for advancing into the GI lumen and observing the intestinal wall.…”