title: The utility of a multibending endoscope for selective cannulation during ERCP in patients with a Billroth II gastrectomy (with video).
abstract: BACKGROUND
  Selective cannulation in patients with a Billroth II gastrectomy is still challenging.
  
  
  OBJECTIVE
  To evaluate the usefulness of a multibending, forward-viewing endoscope (M-scope) for selective cannulation during diagnostic or therapeutic ERCP in patients with a Billroth II gastrectomy.
  
  
  METHODS
  Case series.
  
  
  METHODS
  Tertiary center.
  
  
  METHODS
  Fourteen patients having biliary disease with a Billroth II gastrectomy in whom selective cannulation failed when using a conventional forward-viewing endoscope.
  
  
  METHODS
  In all cases, we attempted selective biliary cannulation for ERCP with a single-bending, forward-viewing endoscope for 10 minutes. After failure with the conventional endoscope, we retried selective cannulation with the M-scope for 10 minutes. After cannulation, the diagnostic or therapeutic endoscopic procedures were performed.
  
  
  METHODS
  We assessed the success rate of selective cannulation, the possibility of therapeutic approaches, and procedure-related complications.
  
  
  RESULTS
  In all cases, we successfully reached the ampulla of Vater with the M-scope. The overall success rate of selective cannulation with the M-scope was 92.9% (13/14). One patient developed mild pancreatitis. Therapeutic procedures such as sphincterotomy, balloon dilatation, stone removal, and biliary drainage were all possible.
  
  
  CONCLUSIONS
  Small number of patients; uncontrolled, single-center study.
  
  
  CONCLUSIONS
  The M-scope seems to be helpful for selective cannulation during ERCP in patients with a Billroth II gastrectomy. All diagnostic and therapeutic procedures were possible through the M-scope.
authors.affiliation: Department of Internal Medicine, Digestive Disease Center, Soon Chun Hyang University School of Medicine, Bucheon and Seoul, Korea.
authors.forename: Hyun Cheol
authors.initials: HC
authors.lastname: Koo
authors.forename: Jong Ho
authors.initials: JH
authors.lastname: Moon
authors.forename: Hyun Jong
authors.initials: HJ
authors.lastname: Choi
authors.forename: Bong Min
authors.initials: BM
authors.lastname: Ko
authors.forename: Su Jin
authors.initials: SJ
authors.lastname: Hong
authors.forename: Young Koog
authors.initials: YK
authors.lastname: Cheon
authors.forename: Young Deok
authors.initials: YD
authors.lastname: Cho
authors.forename: Joon Seong
authors.initials: JS
authors.lastname: Lee
authors.forename: Moon Sung
authors.initials: MS
authors.lastname: Lee
authors.forename: Chan Sup
authors.initials: CS
authors.lastname: Shim