Double balloon endoscopy increases the ERCP success rate in patients with a history of Billroth II gastrectomy.
OBJECTIVE
To evaluate the effect of double balloon endoscope (DBE) on the endoscopic retrograde cholangiopancreatography (ERCP) success rate in patients with a history of Billroth II (B II) gastrectomy.


METHODS
From April 2006 to March 2007, 32 patients with a B II gastrectomy underwent 34 ERCP attempts. In all cases, the ERCP procedures were started using a duodenoscope. If intubation of the afferent loop or reaching the papilla failed, we changed to DBE for the ERCP procedure (DBE-ERCP). We assessed the success rate of afferent loop intubation, reaching the major papilla, selective cannulation, possibility of therapeutic approaches, procedure-related complications, and the overall success rate.


RESULTS
Among the 32 patients with a history of B II gastrectomy, the duodenoscope was successfully passed up to the papilla in 22 patients (69%), and cannulation was successfully performed in 20 patients (63%). Six patients (2 with failure in afferent loop intubation and 4 with failure in reaching the papilla) underwent DBE-ERCP. The DBE reached the papilla in all the 6 patients (100%) and selective cannulation was successful in 5 patients (83%). Four patients (67%) who had common bile duct stones were successfully treated. One patient underwent diagnostic ERCP only and the other one, in whom selective cannulation failed, was diagnosed with papilla cancer proven by biopsy. There were no complications related to the DBE. The overall ERCP success rate increased to 88% (28/32).


CONCLUSIONS
The overall ERCP success rate increases with DBE in patients with a previous B II gastrectomy.
Lin
Cheng-Hui
CH
Division of Digestive Therapeutic Endoscopy, Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan, China.
Tang
Jui-Hsiang
JH
Cheng
Chi-Liang
CL
Tsou
Yung-Kuan
YK
Cheng
Hao-Tsai
HT
Lee
Mu-Hsien
MH
Sung
Kai-Feng
KF
Lee
Ching-Song
CS
Liu
Nai-Jen
NJ
D002404:Catheterization; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000379:methods*; D020698:Duodenoscopes; D005743:Gastrectomy / Q000379:methods*; D005763:Gastroenterostomy; D006801:Humans; D012189:Retrospective Studies; D016896:Treatment Outcome