Endoscopic retrograde cholangiopancreatography in post-Whipple patients

Abstract

When performed by experienced endoscopists, ERCP in patients with prior pancreaticoduodenectomy is safe, with a high success rate for biliary indications and a low success rate for pancreatic duct indications. Better methods of achieving pancreatic duct cannulation after pancreaticoduodenectomy are needed.

Endoscopic ultrasound‐guided pancreatic duct drainage

“…In our institution, we often consider EUS-guided MPD drainage before ERP in patients with a pancreaticoduodenectomy due to the higher reported success rate with this procedure [23][24][25][26][27]. The option of EUS-guidance should be considered relatively early in a difficult cannulation as same-day ERP was associated with a higher rate of technical failure [8].…”

Interventional balloon-enteroscopy

“…6. In Billroth-2 and in pylorus-preserving pancreatoduodenectomy (PPPD) endoscopic retrograde cholangiography (ERC) is successful with use of conventional endoscopes such as duodenoscope or forward viewing enteroscope in 80-90% of cases [39][40][41][42] , but in Roux-Y anatomy, access rates are low with these A C B D Figure 5. removal of a foreign body from a small bowel diverticulum by Be.…”

Endoscopic retrograde cholangiopancreatography complications: Techniques to reduce risk and management strategies

“…178 Post-Whipple (pancreaticoduodenectomy) anatomy does not appear to significantly increase the risk of perforation during ERCP. 179 It is important to consider that various risk factors may predispose to each type of perforation. Type 1 perforations may be more likely in Billroth II anatomy and older patients due to fixed position, immobility and fragility of the bowel wall.…”