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