Efficacy and Safety of Endoscopic Papillary Balloon Dilation Using Cap-Fitted Forward-Viewing Endoscope in Patients Who Underwent Billroth II Gastrectomy

Abstract

Background/AimsEndoscopic exploration of the common bile duct (CBD) is difficult and dangerous in patients with Billroth II gastrectomy (B-II). Endoscopic papillary balloon dilation (EPBD) via a cap-fitted forward-viewing endoscope has been reported to be an effective and safe procedure. We analyzed the technical success and complications of EPBD in patients who underwent B-II.MethodsThirty-six consecutive patients with B-II were enrolled from among 2,378 patients who had undergone endoscopic retrograde cholangiopancreatography in a single institute in the last 4 years. The EPBD procedure was carried out using a cap-fitted forward-viewing endoscope with 8-mm balloon catheters for 60 seconds. We analyzed the rates of CBD exploration, technical success, and complications.ResultsAfferent loop intubation was performed in all patients and selective cannulation of the bile duct was performed in 32 patients (88.9%). Complications such as transient hypoxia were observed in two patients (5.6%) and perforation, in three patients (9.7%). The perforation sites were ductal injury in two patients and one patient showed retroperitoneal air alone without symptoms. Three patients manifested different clinical courses of severe acute pancreatitis and peritonitis, transient abdominal pain, and retroperitoneal air alone. The condition of one patient improved with surgery and that of the other two patients, with conservative management.ConclusionsPatients with perforation during EPBD in B-II showed different clinical courses. Tailored treatment strategies are necessary for improving the clinical outcomes.

Challenges of endoscopic retrograde cholangiopancreatography in patients with Billroth II gastrointestinal anatomy: A review article

“…Therapeutic maneuvers that can be conducted in native anatomy can also be done in patients with a Billroth II anatomy after obtaining access to the bile duct with endoscopic sphincterotomy or sphincteroplasty. Using balloon dilatation in conjunction with a limited sphincterotomy can provide safe and beneficial management of patients with large and difficult bile duct stones rather than relying on a sphincterotomy alone …”

Recent Advanced Endoscopic Management of Endoscopic Retrograde Cholangiopancreatography Related Duodenal Perforations

“…Retroperitoneal air alone (type IV) is developed by compressed air leakage [ 38 , 39 ]. It does not need treatment.…”

Which scope is appropriate for endoscopic retrograde cholangiopancreatography after Billroth II reconstruction: An esophagogastroduodenoscope or a colonoscope?

“…However, recently, forward-viewing endoscopes have been used. Byun et al[ 9 ], Park et al[ 12 ], Ki et al[ 17 ], and Jang et al[ 15 ] used an esophagogastroduodenoscope. However, Abdelhafez et al[ 19 ] used a colonoscope, and Itoi et al[ 7 ] and Kawamura et al[ 16 ] used a single-balloon enteroscope.…”

“…Among the reports describing the use of a forward-viewing endoscope, some have described the use of esophagogastroduodenoscopy (EGDS)[ 9 , 12 , 15 , 17 , 19 ], and others have described the use of long endoscopes ( e.g ., a colonoscope, single-balloon endoscope, or double-balloon endoscope)[ 7 , 8 , 16 , 19 ]. Therefore, this study aimed to reveal which scope (an esophagogastroduodenoscope or a colonoscope) is appropriate for ERCP in B-II patients.…”