title: Outcomes of ERCP in Billroth II gastrectomy patients.
abstract: OBJECTIVE
  ERCP is a difficult procedure to perform in Billroth II gastrectomy patients because of altered anatomy. We investigated the outcomes and risk factors for adverse events with ERCP using a cap-fitted forward-viewing endoscope with endoscopic papillary balloon dilation (EPBD) in Billroth II gastrectomy patients.
  
  
  METHODS
  The records for Billroth II gastrectomy patients who underwent ERCP using a cap-fitted forward-viewing endoscope with EPBD at 5 institutions between August 2008 and April 2014 were retrospectively reviewed. The outcomes and risk factors for adverse events resulting from this treatment were analyzed.
  
  
  RESULTS
  In total, 165 patients were identified. ERCP was technically successful in 144 patients (87.3%) and clinically successful in 141 patients (85.5%). Adverse events occurred in 38 patients (23.0%): perforation in 3 cases (1.8%), pancreatitis in 13 cases (7.9%), and asymptomatic hyperamylasemia in 22 patients (13.3%). In univariate analysis, ≥2 ERCP sessions, periampullary diverticulum, and common bile duct (CBD) stone size ≥ 12 mm were found to be associated with ERCP-related adverse events. In multivariate analysis, ≥2 ERCP sessions (odds ratio [OR], 4.762; 95% confidence interval [CI], 1.472-15.402; P = .009) and a CBD stone size ≥ 12 mm (OR, 3.213; 95% CI, 1.140-9.057; P = .027) were significant.
  
  
  CONCLUSIONS
  ERCP using a cap-fitted forward-viewing endoscope with EPBD is feasible in Billroth II gastrectomy patients. In patients with ≥2 ERCP sessions or a CBD stone size ≥ 12 mm, special attention should be paid to the possible occurrence of significant adverse events.
authors.affiliation: Department of Internal Medicine, Hallym University Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, Korea.
authors.forename: Tae Young
authors.initials: TY
authors.lastname: Park
authors.affiliation: Department of Internal Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea.
authors.forename: Jong Sik
authors.initials: JS
authors.lastname: Kang
authors.affiliation: Division of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Tae Jun
authors.initials: TJ
authors.lastname: Song
authors.affiliation: Division of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Sang Soo
authors.initials: SS
authors.lastname: Lee
authors.affiliation: Department of Health Screening and Promotion Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Hyuk
authors.initials: H
authors.lastname: Lee
authors.affiliation: Department of Internal Medicine, Inje University Busan Paik Hospital, Busan, Korea.
authors.forename: Jung Sik
authors.initials: JS
authors.lastname: Choi
authors.affiliation: Department of Internal Medicine, Gyeongsang National University College of Medicine, Jinju, Korea.
authors.forename: Hong Jun
authors.initials: HJ
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, Eulgi University College of Medicine, Daejeon, Korea.
authors.forename: Ji Woong
authors.initials: JW
authors.lastname: Jang
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D014670:Ampulla of Vater / Q000601:surgery*; D001649:Bile Duct Diseases / Q000601:surgery; D001650:Bile Duct Neoplasms / Q000601:surgery*; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000295:instrumentation / Q000379:methods*; D042883:Choledocholithiasis / Q000601:surgery*; D003251:Constriction, Pathologic; D004106:Dilatation; D005260:Female; D005743:Gastrectomy; D005763:Gastroenterostomy; D006801:Humans; D007416:Intestinal Perforation / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D010190:Pancreatic Neoplasms / Q000601:surgery*; D010195:Pancreatitis / Q000453:epidemiology; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors