title: Feasibility of cap-assisted endoscopic retrograde cholangiopancreatography in patients with altered gastrointestinal anatomy.
abstract: OBJECTIVE
  Endoscopic retrograde cholangiopancreatography (ERCP) is technically challenging in patients with altered gastrointestinal (GI) anatomy. We evaluated the feasibility of cap-assisted ERCP in patients with altered GI anatomy.
  
  
  METHODS
  The outcome of ERCP procedures (n=136) was analyzed in 78 patients with Billroth II (B-II) gastrectomy (n=72), Roux-en-Y total gastrectomy (n=4), and hepaticoduodenostomy (n=2). The intubation rate for reaching the papilla of Vater (POV), deep biliary cannulation rate, therapeutic interventions and procedure-related complications were analyzed. All of the procedures were conducted using a cap-fitted forward-viewing endoscope.
  
  
  RESULTS
  The rate of access to the POV was 97.1% (132/136). In cases with successful access, selective biliary cannulation was achieved in 98.5% (130/132) of the patients. The successful biliary cannulation rates were 100% (125/125) for B-II gastrectomy, 50% (2/4) for Roux-en-Y gastrectomy and 100% (3/3) for hepaticoduodenostomy. After selective biliary cannulation, therapeutic interventions, including stone extraction (n=57), sphincterotomy (n=54), stent placement (n=37), nasobiliary drainage (n=20), endoscopic papillary balloon dilatation (n=7) and mechanical lithotripsy (n=15), were performed successfully. The procedure-related complication rate was 8.8% (12/136), including immediate bleeding (5.9%, 8/136), pancreatitis (2.2%, 3/136), and perforation (0.7%, 1/136). There were no procedure-related deaths.
  
  
  CONCLUSIONS
  Cap-assisted ERCP is efficient and safe in patients with altered GI anatomy.
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea.
authors.forename: Ho Seok
authors.initials: HS
authors.lastname: Ki
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea.
authors.forename: Chang Hwan
authors.initials: CH
authors.lastname: Park
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea.
authors.forename: Chung Hwan
authors.initials: CH
authors.lastname: Jun
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea.
authors.forename: Seon Young
authors.initials: SY
authors.lastname: Park
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea.
authors.forename: Hyun Soo
authors.initials: HS
authors.lastname: Kim
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea.
authors.forename: Sung Kyu
authors.initials: SK
authors.lastname: Choi
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea.
authors.forename: Jong Sun
authors.initials: JS
authors.lastname: Rew
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000379:methods*; D004385:Duodenostomy / Q000379:methods; D005240:Feasibility Studies; D005260:Female; D005743:Gastrectomy / Q000379:methods; D015390:Gastric Bypass / Q000379:methods; D041981:Gastrointestinal Tract / Q000002:abnormalities*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome
keywords: Billroth II gastrectomy; Cap; Cholangiopancreatography, endoscopic retrograde