Cap-assisted ERCP in patients with a Billroth II gastrectomy.
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.
Park
Chang-Hwan
CH
Division of Gastroenterology, Department of Internal Medicine, Chonnam National University Medical School, Gwangju, South Korea.
Lee
Wan-Sik
WS
Joo
Young-Eun
YE
Kim
Hyun-Soo
HS
Choi
Sung-Kyu
SK
Rew
Jong-Sun
JS
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*