title: Retrieval-balloon-assisted enterography for ERCP after Billroth II gastroenterostomy and Braun anastomosis.
abstract: OBJECTIVE
  To describe an optimal route to the Braun anastomosis including the use of retrieval-balloon-assisted enterography.
  
  
  METHODS
  Patients who received a Billroth II gastroenterostomy (n = 109) and a Billroth II gastroenterostomy with Braun anastomosis (n = 20) between January 2009 and May 2013 were analyzed in this study. Endoscopic retrograde cholangiopancreatography (ERCP) was performed under fluoroscopic control using a total length of 120 cm oblique-viewing duodenoscope with a 3.7-mm diameter working channel. For this procedure, we used a triple-lumen retrieval balloon catheter in which a 0.035-inch guidewire could be inserted into the "open-channel" guidewire lumen while the balloon could be simultaneously injected and inflated through the other 2 lumens.
  
  
  RESULTS
  For the patients with Billroth II gastroenterostomy and Braun anastomosis, successful access to the papilla was gained in 17 patients (85%) and there was therapeutic success in 16 patients (80%). One patient had afferent loop perforation, but postoperative bleeding did not occur. For Billroth II gastroenterostomy, there was failure in accessing the papilla in 15 patients (13.8%). ERCP was unsuccessful because of tumor infiltration (6 patients), a long afferent loop (9 patients), and cannulation failure (4 patients). The papilla was successfully accessed in 94 patients (86.2%), and there was therapeutic success in 90 patients (82.6%). Afferent loop perforation did not occur in any of these patients. One patient had hemorrhage 2 h after ERCP, which was successfully managed with conservative treatment.
  
  
  CONCLUSIONS
  Retrieval-balloon-assisted enterography along an optimal route may improve the ERCP success rate after Billroth II gastroenterostomy and Braun anastomosis.
authors.affiliation: Wen-Guang Wu, Wen-Jie Zhang, Jun Gu, Ming-Ning Zhao, Ming Zhuang, Ying-Bin Liu, Xue-Feng Wang, Laboratory of General Surgery and Department of General Surgery, Xinhua Hospital, Affiliated to Shanghai Jiao Tong University, School of Medicine, Shanghai 200092, China.
authors.forename: Wen-Guang
authors.initials: WG
authors.lastname: Wu
authors.affiliation: Wen-Guang Wu, Wen-Jie Zhang, Jun Gu, Ming-Ning Zhao, Ming Zhuang, Ying-Bin Liu, Xue-Feng Wang, Laboratory of General Surgery and Department of General Surgery, Xinhua Hospital, Affiliated to Shanghai Jiao Tong University, School of Medicine, Shanghai 200092, China.
authors.forename: Wen-Jie
authors.initials: WJ
authors.lastname: Zhang
authors.affiliation: Wen-Guang Wu, Wen-Jie Zhang, Jun Gu, Ming-Ning Zhao, Ming Zhuang, Ying-Bin Liu, Xue-Feng Wang, Laboratory of General Surgery and Department of General Surgery, Xinhua Hospital, Affiliated to Shanghai Jiao Tong University, School of Medicine, Shanghai 200092, China.
authors.forename: Jun
authors.initials: J
authors.lastname: Gu
authors.affiliation: Wen-Guang Wu, Wen-Jie Zhang, Jun Gu, Ming-Ning Zhao, Ming Zhuang, Ying-Bin Liu, Xue-Feng Wang, Laboratory of General Surgery and Department of General Surgery, Xinhua Hospital, Affiliated to Shanghai Jiao Tong University, School of Medicine, Shanghai 200092, China.
authors.forename: Ming-Ning
authors.initials: MN
authors.lastname: Zhao
authors.affiliation: Wen-Guang Wu, Wen-Jie Zhang, Jun Gu, Ming-Ning Zhao, Ming Zhuang, Ying-Bin Liu, Xue-Feng Wang, Laboratory of General Surgery and Department of General Surgery, Xinhua Hospital, Affiliated to Shanghai Jiao Tong University, School of Medicine, Shanghai 200092, China.
authors.forename: Ming
authors.initials: M
authors.lastname: Zhuang
authors.affiliation: Wen-Guang Wu, Wen-Jie Zhang, Jun Gu, Ming-Ning Zhao, Ming Zhuang, Ying-Bin Liu, Xue-Feng Wang, Laboratory of General Surgery and Department of General Surgery, Xinhua Hospital, Affiliated to Shanghai Jiao Tong University, School of Medicine, Shanghai 200092, China.
authors.forename: Yi-Jing
authors.initials: YJ
authors.lastname: Tao
authors.affiliation: Wen-Guang Wu, Wen-Jie Zhang, Jun Gu, Ming-Ning Zhao, Ming Zhuang, Ying-Bin Liu, Xue-Feng Wang, Laboratory of General Surgery and Department of General Surgery, Xinhua Hospital, Affiliated to Shanghai Jiao Tong University, School of Medicine, Shanghai 200092, China.
authors.forename: Ying-Bin
authors.initials: YB
authors.lastname: Liu
authors.affiliation: Wen-Guang Wu, Wen-Jie Zhang, Jun Gu, Ming-Ning Zhao, Ming Zhuang, Ying-Bin Liu, Xue-Feng Wang, Laboratory of General Surgery and Department of General Surgery, Xinhua Hospital, Affiliated to Shanghai Jiao Tong University, School of Medicine, Shanghai 200092, China.
authors.forename: Xue-Feng
authors.initials: XF
authors.lastname: Wang
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D057785:Catheters; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects / Q000295:instrumentation*; D002761:Cholangitis / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D020698:Duodenoscopes; D004867:Equipment Design; D005260:Female; D042882:Gallstones / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D005763:Gastroenterostomy / Q000009:adverse effects; D006801:Humans; D041781:Jaundice, Obstructive / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000601:surgery*; D016896:Treatment Outcome
keywords: Billroth II gastroenterostomy; Braun anastomosis; Duodenoscope; Efferent loop; Endoscopic retrograde cholangiopancreatography; Enterography success rate; Gastrojejunal anastomosis; Optimal enterography route; Retrieval-balloon-assisted enterography; Therapeutic success rate