Diagnostic and therapeutic endoscopic retrograde cholangiopancreaticography after Billroth II gastrectomy – safe provision in a district general hospital

Abstract

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

Recurrence of common bile duct stones following laparoscopic common bile duct exploration: a multicenter study

“…In the hospitals participating in our study, the proportion of LCBDE for treatment of CBDS patients was 1.8À19% for each hospital (data not shown). However, patients with multiple stones, duodenal diverticulum, severe strictures or obstructions, and severe kyphosis will require surgical methods [11,17,[20][21][22].…”

Percutaneous Placement of Self-Expandable Metallic Stents in Patients with Obstructive Jaundice Secondary to Metastatic Gastric Cancer after Gastrectomy

“…Two studies have shown that surgical treatment is associated with higher postoperative mortality, morbidity and a longer hospital stay than non-surgical drainages (24, 25). Endoscopic retrograde cholangiography (ERCP) is usually difficult in these patients because of a distorted bowel loop due to the Billroth II reconstruction or Rouxen-Y esophagojejunostomy (26, 27). Afferent loop perforation is a specific complication of ERCP in these patients and these patients have a mortality rate varying from 0.7-5% (27).…”

“…Endoscopic retrograde cholangiography (ERCP) is usually difficult in these patients because of a distorted bowel loop due to the Billroth II reconstruction or Rouxen-Y esophagojejunostomy (26, 27). Afferent loop perforation is a specific complication of ERCP in these patients and these patients have a mortality rate varying from 0.7-5% (27). Therefore, we use PTBD as an initial treatment for patients with malignant biliary obstruction caused by metastatic gastric cancers.…”

EUS in patients with surgically altered upper GI anatomy

“…In large case series, technical failures have been reported for Billroth II (13% to 48%), [1][2][3][4][5][6][7][8] Whipple (31% to 46%), 9,10 and Roux-en-Y (33% to 67%) 11,12 anatomy. The reported rate of perforation for ERCP in this setting is 0% to 18%, with a mortality of 0% to 3%.…”

“…The reported rate of perforation for ERCP in this setting is 0% to 18%, with a mortality of 0% to 3%. [1][2][3][4][5][6][7][8][9][10][11][12] It is worth noting that these studies were generally conducted at expert centers by endoscopists with a special interest in surgically altered anatomy. As a result of this ERCP experience, surgically altered anatomy may be considered a relative contraindication to EUS by some physicians.…”