title: Usefulness of Forward-Viewing Endoscope for Endoscopic Retrograde Cholangiopancreatography in Patients with Billroth II Gastrectomy.
abstract: OBJECTIVE
  Patients undergoing Billroth II (B II) gastrectomy are at higher risk of perforation during endoscopic retrograde cholangiopancreatography (ERCP). We assessed the success rate and safety of forward-viewing endoscopic biliary intervention in patients with B II gastrectomy.
  
  
  METHODS
  A total of 2,280 ERCP procedures were performed in our institution between October 2008 and June 2011. Of these, forward-viewing endoscopic biliary intervention was performed in 46 patients (38 men and 8 women with B II gastrectomy). Wire-guided selective cannulations of the common bile duct using a standard catheter and guide wire were performed in all patients.
  
  
  RESULTS
  The success rate of afferent loop entrance was 42 out of 46 patients (91.3%) and of biliary cannulation after the approach of the papilla was 42 out of 42 patients (100%). No serious complications were encountered, except for one case of small perforation due to endoscopic sphincterotomy site injury.
  
  
  CONCLUSIONS
  When a biliary endoscopist has less experience and patient volume is low, ERCP with a forward-viewing endoscope is preferred because of its ease and safety in all patients with prior B II gastrectomies. Also, forward-viewing endoscope can be used to improve the success rate of biliary intervention in B II patients.
authors.affiliation: Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea.
authors.forename: Jong Won
authors.initials: JW
authors.lastname: Byun
authors.forename: Jae Woo
authors.initials: JW
authors.lastname: Kim
authors.forename: Se Yong
authors.initials: SY
authors.lastname: Sung
authors.forename: Ho Yeon
authors.initials: HY
authors.lastname: Jung
authors.forename: Hyo Keun
authors.initials: HK
authors.lastname: Jeon
authors.forename: Hong Jun
authors.initials: HJ
authors.lastname: Park
authors.forename: Moon Young
authors.initials: MY
authors.lastname: Kim
authors.forename: Hyun Soo
authors.initials: HS
authors.lastname: Kim
authors.forename: Soon Koo
authors.initials: SK
authors.lastname: Baik