Endoscopic retrograde cholangiopancreatography and needle-knife sphincterotomy in patients with Billroth II gastrectomy: a comparative study of the forward-viewing endoscope and the side-viewing duodenoscope.
OBJECTIVE
A prospective, randomized study was carried out to compare the success and complication rates associated with the forward-viewing endoscope and side-viewing duodenoscope in conducting endoscopic retrograde cholangiopancreatography (ERCP) and needle-knife sphincterotomy in patients with a Billroth II gastrectomy.


METHODS
The study included 45 patients with a Billroth II gastrectomy who required ERCP and endoscopic sphincterotomy (EST) for evaluation and management of pancreaticobiliary disease. The patients were randomly assigned to receive ERCP and EST with either a forward-viewing endoscope or a side-viewing duodenoscope.


RESULTS
Cannulation of the papilla was successful in 68% (15 of 22) in the side-viewing duodenoscope group, and in 87% (20 of 23) in the forward-viewing endoscope group. Failures of cannulation occurred in seven patients in the side-viewing duodenoscope group, caused by jejunal perforation during insertion (n = 4), by a long afferent loop (n = 1), by a complaint of severe abdominal pain (n = 1), and by failure to enter the afferent loop (n = 1). In the forward-viewing endoscope group, failure occurred in three patients due to the long afferent loop (n = 2) and to an inability to cannulate despite identification of the papilla (n = 1). Sphincterotomy was successfully completed in eight of ten patients (80%) in the side-viewing duodenoscope group, and in ten of twelve patients (83%) in the forward-viewing endoscope group.


CONCLUSIONS
For ERCP and EST in patients with Billroth II gastrectomy, the forward-viewing endoscope is as effective as the side-viewing duodenoscope, but it may be the safer of the two instruments. The forward-viewing endoscope can be recommended for ERCP and EST in patients with a Billroth II gastrectomy.
Kim
M H
MH
Dept. of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Lee
S K
SK
Lee
M H
MH
Myung
S J
SJ
Yoo
B M
BM
Seo
D W
DW
Min
Y I
YI
D015746:Abdominal Pain / Q000209:etiology; D000328:Adult; D000368:Aged; D014670:Ampulla of Vater / Q000473:pathology; D000714:Anastomosis, Surgical; D001649:Bile Duct Diseases / Q000175:diagnosis / Q000601:surgery; D002404:Catheterization / Q000295:instrumentation; D002760:Cholangiopancreatography, Endoscopic Retrograde; D020698:Duodenoscopes; D004384:Duodenoscopy / Q000009:adverse effects; D004867:Equipment Design; D005260:Female; D005743:Gastrectomy; D006801:Humans; D007583:Jejunum / Q000293:injuries / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009339:Needles; D010182:Pancreatic Diseases / Q000175:diagnosis / Q000601:surgery; D011446:Prospective Studies; D012449:Safety; D016717:Sphincterotomy, Endoscopic / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods; D016896:Treatment Outcome