title: Endoscopic retrograde cholangiopancreatography after pancreaticoduodenectomy for benign and malignant disease: indications and technical outcomes.
abstract: OBJECTIVE
  Patients undergoing pancreaticoduodenectomy develop postoperative complications related to surgery and their disease. Very little data are available on the role or success of endoscopic retrograde cholangiopancreatography (ERCP) in such patients. The aim of this study was to evaluate the indications and role of diagnostic and therapeutic ERCP after pancreaticoduodenectomy for both benign and malignant disease.
  
  
  METHODS
  This study was a 10-year (1990 - 2000) single institution retrospective review of all ERCPs performed on patients who had undergone pancreaticoduodenectomy surgery. Indications for the ERCP and technical procedural success were studied.
  
  
  RESULTS
  29 patients with a pancreaticoduodenectomy underwent 56 ERCPs. Reasons for surgery were neoplasia and chronic pancreatitis. Indications for ERCP included evaluation of jaundice and pain. Technical success related to the clinical indication (jaundice 69 %, pain 54 %).
  
  
  CONCLUSIONS
  ERCP plays an important role in the management of postpancreatic surgery problems including biliary and anastomotic strictures, and should be the modality of choice. However, surgical technique may make the afferent limb inaccessible, and the ductal anastomosis difficult to identify in patients with some types of pancreaticoduodenectomy. Closer collaboration between surgeon and endoscopist may allow alterations in surgical technique to improve postoperative ERCP success.
authors.affiliation: Division of Gastroenterology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. jfarrell@mednet.ucla.edu
authors.forename: J
authors.initials: J
authors.lastname: Farrell
authors.forename: D
authors.initials: D
authors.lastname: Carr-Locke
authors.forename: T
authors.initials: T
authors.lastname: Garrido
authors.forename: F
authors.initials: F
authors.lastname: Ruymann
authors.forename: S
authors.initials: S
authors.lastname: Shields
authors.forename: J
authors.initials: J
authors.lastname: Saltzman
mesh_terms: D021721:Balloon Occlusion; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000379:methods*; D006801:Humans; D010182:Pancreatic Diseases / Q000175:diagnosis* / Q000628:therapy*; D016577:Pancreaticoduodenectomy / Q000379:methods*