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Ann R Coll Surg Engl 2005; 87: 274-6 274Endoscopic retrograde cholangiopancreatography (ERCP) is widely used in the diagnosis and treatment of pancreaticbiliary disease.1 It is available in most acute hospitals in the UK. However, there are potential difficulties in carrying out this examination following a Billroth II gastrectomy and few centres have wide experience of ERCP in this situation. In this study, we have evaluated the results of ERCP in Billroth II gastrectomy patients treated in a district general hospital over a 10-year period. The aim of the study was to evaluate the success rate, safety and effectiveness of ERCP in Billroth II gastrectomy patients and consider the future provision of this service. Patients and MethodsThe details of patients who undergo an ERCP are held on a database in the radiology department. Those cases that had previously undergone a Billroth II gastrectomy were extracted from this and their notes reviewed. Information was collected on patient demographics, indications for ERCP, technical difficulties, interventional procedures, outcome and complications. A single radiologist (WTY) carried out all the ERCP examinations and all cases were admitted under the care of a surgeon with a gastrointestinal interest (JDS).Examinations were carried out in the radiology department. All patients received Midazolam (HypnovalRRR) sedation, Pethidine analgesia and oxygen administered by nasal cannula and monitored by pulse oximetry. A single dose of Ciprofloxacin was administered at the start of the procedure. All examinations were carried out using an Olympus side-viewing duodenoscope (JF1T10 -distal tip diameter 12 mm, channel diameter 3.2 mm; TJF 200 -distal tip diameter 13.5 mm, channel diameter 4.2 mm; TJF 240 -distal tip diameter 13.5 mm, channel diameter 4.2 mm). The afferent loop was intubated with minimal air

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Left sided gallbladders are rare and this case describes cholecystectomy without additional port placement.