Cannulating the papilla from the reverse position. Therapeutic ERCP in patients with Billroth II gastrectomy

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Annals of Gastroenterology
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Cannulating the papilla from the reverse position. Therapeutic ERCP in patients with Billroth II gastrectomy (EN)

Kasapidis, P.

Therapeutic ERCP in patients with Billroth II gastrectomy can be more difficult, because of a surgically altered anatomy and requires a very skilful endoscopist. Most endoscopists recommend the use of a side-viewing duodenoscope. Gastroscopes should be reserved as second choice after a failed attempt with the duodenoscope. Afferent loop intubation is successful in 72-94% of patients. The most serious complication during ERCP is bowel perforation (0,7-2%) caused by manipulations through the afferent loop, while trying to reach the papilla. Selective cannulation and sphincterotomy of the papilla is safely and successfully performed from the reverse position (5 to 6 ‘o clock position, for the common bile duct), with the use of a specifically designed Billroth II sphincterotome. Because of the anatomical changes, diagnostic and therapeutic endoscopic retrograde cholangiopancreatography (ERCP) is more demanding, in technical terms, in patients with a Billorth-II (B-II) gastrectomy, as compared to the procedure in an intact upper alimentary tract. Conceivably the respective success rate of ERCP is 50-90% and 85-95%. The endoscopist performing ERCP in a B-II patient has to consider and overcome the following issues: I) to choose the appropriate endoscope, II) to intubate the afferent loop, III) to reach the duodenal stump and papilla, IV) to selectively cannulate the papilla and V) to perform an endoscopic sphincterotomy. The whole issue has been addressed by specialists shortly after the introduction of ERCP in 19681 and endoscopic sphinterotomy in 1973.2 However, interest in these issues continues to the present and will be discussed herein. (EN)


Αγγλική γλώσσα


Hellenic Society of Gastroenterology (EN)

Annals of Gastroenterology; Volume 19, No 2 (2006) (EN)

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