title: Use of the Conventional Side-viewing Duodenoscope for Successful Endoscopic Retrograde Cholangiopancreatography in Postgastrectomy Patients.
abstract: OBJECTIVE
  The aim of this study was to evaluate the usefulness of the conventional side-viewing duodenoscope for successful endoscopic retrograde cholangiopancreatography (ERCP) in postgastrectomy patients.
  
  
  METHODS
  A total of 220 consecutive patients with bile duct stones or a distal common bile duct stricture who had previously undergone gastrectomy and were referred for ERCP were analyzed for the outcome of their ERCP. All ERCP procedures were performed using a conventional side-viewing duodenoscope. In patients who had undergone a Billroth II gastroenterostomy and total gastrectomy with Roux-en-Y reconstruction, we also used the procedure of retrieval balloon-assisted enterography.
  
  
  RESULTS
  The study group included 220 patients who had previously undergone gastrectomy (77 women and 143 men; mean age, 72.2 y; range, 11 to 93 y). The overall enterography success rate was 90.5% (199/220), and the diagnostic and ERCP success rates were both 88.6% (195/220). Endoscopy was unsuccessful in 21 patients who received Billroth II gastroenterostomy and Roux-en-Y reconstruction. After successful endoscopy, diagnostic and ERCP success was not achieved in 4 patients with Billroth II gastroenterostomy, with or without Braun anastomosis, due to cannulation failure. The procedure-related complication rate was 5.5% (12/220), including immediate bleeding (0.9%, 2/220), pancreatitis (4.1%, 9/220), and perforation (0.5%, 1/220). There were no procedure-related deaths.
  
  
  CONCLUSIONS
  The side-viewing duodenoscope is a useful instrument for performing successful ERCP in patients postgastrectomy. In addition, retrieval balloon-assisted enterography may improve the enterography success rate in postgastrectomy patients with Billroth II and Roux-en-Y reconstruction.
authors.affiliation: Departments of *General Surgery and Laboratory of General Surgery, Xinhua Hospital, Affiliated to Shanghai Jiao Tong University, School of Medicine and Institute of Biliary Tract Disease, Shanghai Jiao Tong University School of Medicine †Pediatric Digestive Nutrition, Xinhua Hospital, Affiliated to Shanghai Jiao Tong University, School of Medicine, Shanghai, China.
authors.forename: Wen-Guang
authors.initials: WG
authors.lastname: Wu
authors.forename: Jia-wei
authors.initials: JW
authors.lastname: Mei
authors.forename: Ming-Ning
authors.initials: MN
authors.lastname: Zhao
authors.forename: Wen-Jie
authors.initials: WJ
authors.lastname: Zhang
authors.forename: Jun
authors.initials: J
authors.lastname: Gu
authors.forename: Yi-Jing
authors.initials: YJ
authors.lastname: Tao
authors.forename: Ying-Bin
authors.initials: YB
authors.lastname: Liu
authors.forename: Xue-Feng
authors.initials: XF
authors.lastname: Wang
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000713:Anastomosis, Roux-en-Y; D002648:Child; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects / Q000295:instrumentation*; D001651:Cholestasis, Extrahepatic / Q000209:etiology / Q000628:therapy*; D003251:Constriction, Pathologic / Q000150:complications / Q000628:therapy; D020698:Duodenoscopes; D005260:Female; D042882:Gallstones / Q000628:therapy*; D005743:Gastrectomy; D005763:Gastroenterostomy; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult