title: Cap-assisted ERCP in patients with a Billroth II gastrectomy.
abstract: BACKGROUND
  ERCP is difficult in patients with a Billroth II gastrectomy because of anatomical changes.
  
  
  OBJECTIVE
  Cap-assisted ERCP can improve the cannulation rate and the success rate of stone removal.
  
  
  METHODS
  Case series.
  
  
  METHODS
  A tertiary referral center.
  
  
  METHODS
  Ten consecutive patients with bile-duct stones (9) or a distal common bile duct stricture (1), who had previously undergone Billroth II gastrectomy and were referred for ERCP, were analyzed for the outcome of their ERCP. All procedures were carried out with a cap-fitted regular forward-viewing endoscope.
  
  
  METHODS
  Ability to perform afferent loop intubation and bile-duct cannulation.
  
  
  RESULTS
  Of 10 patients in whom ERCP was attempted, afferent loop intubation and selective bile-duct cannulation were achieved in all patients (100%). Endoscopic sphincterotomy (EST) was successful in all 10 patients (100%). All stones were removed by EST alone in 7 patients and by both EST and endoscopic papillary balloon dilation in 2 patients. There were no serious complications in the patients.
  
  
  CONCLUSIONS
  Small sample size, single-center experience.
  
  
  CONCLUSIONS
  Diagnostic and therapeutic ERCP with a cap-fitted regular forward-viewing endoscope was successful in all patients with a prior Billroth II gastrectomy. The high rate of successful ERCP was achieved by improving afferent loop intubation and bile-duct cannulation with a cap-fitted endoscope.
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Chonnam National University Medical School, Gwangju, South Korea.
authors.forename: Chang-Hwan
authors.initials: CH
authors.lastname: Park
authors.forename: Wan-Sik
authors.initials: WS
authors.lastname: Lee
authors.forename: Young-Eun
authors.initials: YE
authors.lastname: Joo
authors.forename: Hyun-Soo
authors.initials: HS
authors.lastname: Kim
authors.forename: Sung-Kyu
authors.initials: SK
authors.lastname: Choi
authors.forename: Jong-Sun
authors.initials: JS
authors.lastname: Rew
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000295:instrumentation*; D001651:Cholestasis, Extrahepatic / Q000601:surgery*; D004867:Equipment Design; D005260:Female; D042882:Gallstones / Q000601:surgery*; D005763:Gastroenterostomy; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000601:surgery*; D016717:Sphincterotomy, Endoscopic / Q000295:instrumentation*