Endoscopic Sphincterotomy Using an S-shaped Sphincterotome in Patients with a Billroth II or Roux-en-Y Gastrojejunostomy

Abstract

In spite of previous gastrojejunostomy, most patients with Billroth II anastomoses (92%) and many patients with Roux-en-Y reconstructions (33%) can be treated endoscopically for biliary diseases. The use of a conventional side-viewing endoscope in conjunction with an S-shaped sphincterotome can be recommended. This allows safe and successful endoscopic treatment of all patients in whom endoscopic access to the papilla of Vater is possible.

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.…”

Laparoscopy-assisted ERCP: experience of a high-volume bariatric surgery center (with video)

“…Laparoscopic creation of a point of access to the gastric remnant or small bowel allows the duodenoscope to reach the papilla, but carries the inherent risks of general anesthesia and surgery. [2][3][4][5][6][7][8][9] Less-invasive alternatives include advancement of the duodenoscope, 10 enteroscope, or colonoscope via the anatomical route [11][12][13][14] and introduction of the duodenoscope through the gastrostomy or jejunostomy tract. [15][16][17][18] In addition, the use of double-balloon enteroscopes (DBEs) and single-balloon enteroscopes has also been reported to be effective.…”

Endoscopic retrograde cholangiopancreatography in surgically altered anatomy

“…21 In order to improve orientation for cannulation in Biliroth II, several ERCP accessories such as a rotatable sphincterotome, a sigmoid shaped sphincterotome or a straight catheter with groomed distal tip have shown good efficacy (~90%) with low adverse event rates (< 5%). 22,23 Another popular strategy is the use biliary stent as a guide to perform needle knife sphincterotomy with a reported success rate of 83% and early complication rate of 39% (bleeding 16%, pancreatitis 8%, perforation 2%) in a small cohort of 18 patients. 24 In above study, a randomized comparison of trans-papillary balloon dilatation (n = 16) with endoscopic sphincterotomy (n = 18) in Billroth II patients showed similar overall success rates for stone removal with balloon dilation (88%) but without any post-procedure bleeding events.…”