title: Endoscopic retrograde cholangiography using an anterior oblique-viewing endoscope in patients with altered gastrointestinal anatomy.
abstract: BACKGROUND
  Endoscopic retrograde cholangiopancreatography (ERCP) is technically more challenging in patients who have undergone gastrointestinal (GI) reconstruction.
  
  
  OBJECTIVE
  The aim of this study was to evaluate the utility of the anterior oblique-viewing endoscope (AOE) for ERCP in patients with a retained major duodenal papilla after GI reconstruction.
  
  
  METHODS
  This was a retrospective study involving 40 patients (50 procedures) with a retained papilla after GI reconstruction who underwent ERCP using AOE. Reconstruction consisted of Billroth II gastrectomy (BII) in 25 patients (30 procedures) and Roux-en-Y anastomosis (RY) in 15 patients (20 procedures). In RY cases, the long single-balloon enteroscope (LSBE) was exchanged with AOE after reaching the papilla.
  
  
  RESULTS
  The overall rate of reaching the papilla using AOE was 90.0 % (45/50) [BII; 86.7 % (26/30), RY; 95.0 % (19/20)]. The overall rate of biliary cannulation was 97.8 % (44/45) [BII; 100 % (26/26), RY; 94.7 % (18/19)], and the rate of biliary cannulation for intact papilla was 96.6 % (28/29) [BII; 100 % (14/14), RY; 93.3 % (14/15)]. Treatment success rate in cases of successful biliary cannulation was 97.7 % (43/44) [BII; 100 % (26/26), RY; 94.4 % (17/18)]. The rate of adverse events was 6.0 % (3/50) [BII; 3.3 % (1/30), RY; 10.0 % (2/20)], with mild pancreatitis occurring in 3 cases.
  
  
  CONCLUSIONS
  High biliary cannulation and treatment rates can be achieved during ERCP using AOE in altered GI anatomy cases with a retained papilla, as long as the papilla can be reached. In RY cases, exchanging AOE with LSBE is useful after reaching the papilla.
authors.affiliation: Department of Gastroenterology and Hepatology, School of Medicine, St. Marianna University, 2-16-1, Sugao, Miyamae-ku, Kawasaki, 216-8511, Japan, nakahara@marianna-u.ac.jp.
authors.forename: Kazunari
authors.initials: K
authors.lastname: Nakahara
authors.forename: Chiaki
authors.initials: C
authors.lastname: Okuse
authors.forename: Keigo
authors.initials: K
authors.lastname: Suetani
authors.forename: Ryo
authors.initials: R
authors.lastname: Morita
authors.forename: Yosuke
authors.initials: Y
authors.lastname: Michikawa
authors.forename: Shun-Ichiro
authors.initials: S
authors.lastname: Ozawa
authors.forename: Kosuke
authors.initials: K
authors.lastname: Hosoya
authors.forename: Masahito
authors.initials: M
authors.lastname: Nomoto
authors.forename: Shinjiro
authors.initials: S
authors.lastname: Kobayashi
authors.forename: Takehito
authors.initials: T
authors.lastname: Otsubo
authors.forename: Fumio
authors.initials: F
authors.lastname: Itoh
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000713:Anastomosis, Roux-en-Y; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000295:instrumentation* / Q000379:methods* / Q000706:statistics & numerical data; D005260:Female; D005743:Gastrectomy; D006801:Humans; D008297:Male; D012189:Retrospective Studies