Endoscopic retrograde cholangio-pancreatography after conventional Billroth II resection

INTRODUCTION: The ERCP examination after Billroth II gastrectomy is more difficult than in patients with normal anatomy. The success rate is smaller and the complication rate is higher in this situation. AIM: The author compares their results of ERCP performed in patients with conventional Billroth II gastrectomy to the literature data. He analyses the different solutions of technical difficulties on the basis of his own experiences and the literature. PATIENTS AND METHOD: ERCP was tried in 26 patients with Billroth II gastrectomy between 1st March, 1997 and 1st December, 2003 in 37 cases. Indications were: obstructive jaundice in 25 patients and postoperative pancreas fistula in 1 patient. 32 investigations were performed with duodenoscope, 5 with gastroscope. Duodenoscopy was preceded by gastroscopy in 15 cases. RESULTS: The examination was successful in 22 patients (84.6%). Exact diagnosis was achieved in 19 patients (73%), and endoscopic therapy was needed in 15 cases. The therapeutic interventions were successful in 10 patients. CONCLUSION: In author's opinion only ERCP with therapeutic aim gives reason to perform it. He found the balloon dilation of sphincter of Oddi and the needle-knife papillotomy controlled by stent insertion the more effective and safe method to prepare the common bile duct interventions than push-sphincterotomy. Previously performed gastroscopy may facilitate to find the afferent loop and to get there by duodenoscopy.