Endoscopic Retrograde Cholangiopancreatography in Post Gastrectomy Patients

Abstract

Endoscopic retrograde cholangiopancreatography (ERCP) in post-gastrectomy patients with Billroth II (BII) reconstruction and Roux-en-Y (RY) reconstruction presents a challenge to therapeutic endoscopists. Major difficulties, including intubation to the ampulla of Vater, selective cannulation, and ampullary intervention, must be overcome in these patients. Recent data have shown that device-assisted ERCP allows for high success rates in these patients because various devices are useful for overcoming major difficulties. Therefore, good knowledge of postoperative anatomy and various devices is mandatory before performing ERCP procedures for post-gastrectomy patients.

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

“…An ERCP in Billroth II gastrointestinal anatomy is quite difficult to perform. The challenges lie in several factors, which we will discuss in the following paragraphs.…”

Optimal choice of stapler and digestive tract reconstruction method after distal gastrectomy for gastric cancer: A prospective case–control study

“…The B-I type is more aligned with the characteristics of physiological anatomy, can maintain continuity of the digestive tract, and has a low risk of abdominal hernia; however, the operation process of anastomotic tension is high, which increases the risk of anastomotic leakage, thus making it only suitable for distal gastric cancers with small lesions and without pyloric invasion[ 12 ]. The advantage of the B-II reconstruction method is that it is not affected by anastomotic tension during the resection of a sufficient size of the stomach and duodenal bulb; however, it allows easy changes in the physiological and anatomical structure, increases exposure to bile reflux gastritis, and is associated with a high incidence of gastric stump cancer[ 13 ]. Clinical experience and relevant surveys have demonstrated that the combination of mechanical anastomosis in DTR surgery is conducive to shortening the operation time, thereby improving the safety of the procedure, reducing the risk of postoperative syndromes, and increasing the clinical benefit rate for patients[ 14 ].…”

Experience of endoscopic retrograde cholangiopancreatography with side-viewing duodenoscope in patients with previous gastric surgery

“…Indication of previous gastric surgery has affected the success of ERCP due to gastrectomy and reconstruction technique. Peptic ulcer or gastric cancer is the indication of Billroth II gastrec- tomy; however, RNYGJ is performed for gastric cancer or obesity surgery (16,17). In a recent study, peptic ulcer has been the most common indication of gastric surgery with 69.5%, and in 48% of the operated peptic ulcer patients, ERCP was successful.…”