title: Techniques to facilitate ERCP with a conventional endoscope in patients with previous pancreatoduodenectomy.
abstract: There is little guidance on the performance of endoscopic retrograde cholangiopancreatography (ERCP) in patients with previous pancreatoduodenectomy. We reviewed techniques for ERCP with a conventional endoscope and assessed its value in 10 patients with previous pancreatoduodenectomy (15 ERCPs). After exploration of the surgical reconstruction, we used a front-viewing endoscope, and we used a small firm pillow under the abdomen and hand compression for preventing loop formation. Successful insertion to the ductal anastomoses and biliary cannulation were achieved in 13 / 15 procedures (87 %). In 6 procedures where we attempted pancreatic cannulation, we could not identify the pancreatojejunostomy, but after spraying contrast around the suspected location of the ductal anastomosis we obtained a pancreatogram in 4 / 6 procedures (67 %). Endoscopic biliary interventions were successful in 6 / 7 procedures (86 %). No complications were encountered. Use of appropriate techniques makes ERCP with a conventional endoscope feasible, effective, and safe in patients with previous pancreatoduodenectomy. Endoscopic therapy can be performed successfully in the bile duct, but has limited value regarding the pancreatic duct.
authors.affiliation: Third Department of Internal Medicine, Kansai Medical University, Osaka 573-1191, Japan. matsumit@hirakata.kmu.ac.jp
authors.forename: M
authors.initials: M
authors.lastname: Matsushita
authors.forename: H
authors.initials: H
authors.lastname: Takakuwa
authors.forename: K
authors.initials: K
authors.lastname: Uchida
authors.forename: A
authors.initials: A
authors.lastname: Nishio
authors.forename: K
authors.initials: K
authors.lastname: Okazaki
mesh_terms: D000368:Aged; D001660:Biliary Tract Diseases / Q000601:surgery*; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000295:instrumentation* / Q000379:methods*; D020698:Duodenoscopes; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016577:Pancreaticoduodenectomy / Q000295:instrumentation* / Q000379:methods*; D016896:Treatment Outcome