Endoscopic Retrograde Cholangiopancreatography in Patients after Billroth II Gastrectomy

Abstract

Two thousand two hundred and eighteen patients received endoscopic retrograde cholangiopancreatography (ERCP) at Veterans General Hospital-Taipei, from January 1985 to August 1989. Of them, 55 had received subtotal gastrectomy with Biliroth Ⅱ (BⅡ) anastomosis before. Succesrful cannulation of biliary and/or pancreatic duct was achieved in 94.4% of patients without prior gastric operation whereas the successful cannulation rate was 70.9% in patients with prior BⅡ gastrectomy (P＜0.001). Whether the patients had received BⅡ gastrectomy or not, there were no significant differences in the success rates of visualization of the biliary tract (100% vs 92.7%), the pancreatic duct (87.2% vs 80.2%), and both (87.2% vs 72.9%). The causes for unsuccessful ERCP in the BⅡ gastrectomized patients were failure of the endoscope to enter the afferent loop or the afferent loop being too long to reach the papilla. There was no serious complication of ERCP in the patients with BⅡ gastrectomy except one who developed bleeding from the torn duodenal mucosa soon after the procedure. On three patients with malignant obstructive jaundice and one patient with choledocholithiasis, nasobiliary drainage was performed after the diagnostic ERCP. Endoscopic sphincterotomy with stone extraction was performed on one patient with recurrent choledocholithiasis. We conclude that although the type of surgical anastomosis can result in a lower success rate, ERCP remains an useful and accessible diagnostic procedure in the patients with pancreatobiliary disease who had BⅡ gastrectomy.