Nakahara Kazunari, Horaguchi Jun, Fujita Naotaka, Noda Yutaka, Kobayashi Go, Ito Kei, Obana Takashi, Takasawa Osamu
Department of Gastroenterology, Sendai City Medical Center, 5-22-1 Tsurugaya, Miyagino-ku, Sendai, Miyagi, 983-0824, Japan.
J Gastroenterol. 2009;44(3):212-7. doi: 10.1007/s00535-008-2299-x. Epub 2009 Feb 13.
Prior Billroth II gastrectomy is an important factor presenting difficulties in endoscopic retrograde cholangiopancreatography (ERCP) administration. We retrospectively evaluated the usefulness and safety of therapeutic ERCP using an anterior oblique-viewing endoscope for bile duct stones in patients with prior Billroth II gastrectomy.
Forty-three patients with bile duct stones after Billroth II gastrectomy who underwent ERCP from January 1998 to February 2008 were enrolled in this study. We used anterior oblique-viewing endoscopes for all procedures. Endoscopic sphincterotomy was performed using a needle knife guided by a biliary stent. A total of 808 patients without gastrectomy who had undergone ERCP for bile duct stones in the same period were reviewed as controls.
The success rate of access to the papilla of Vater was 88.4%, and the average time required for such access was 13 min. In cases of successful access, selective cannulation of the bile duct and complete stone removal were achieved in 94.7% and 94.6% of patients, respectively. The incidence of complications was 4.7%. As for the success rate of selective cannulation, complete stone removal ratio, and the incidence of complications, there were no significant differences compared with the control group.
Use of an anterior oblique-viewing endoscope enables good success rates in selective cannulation and complete stone removal to be achieved in patients with prior Billroth II gastrectomy. The safety of therapeutic ERCP for removal of bile duct stones in those patients is comparable to that in patients with normal anatomy.
既往毕罗Ⅱ式胃切除术是内镜逆行胰胆管造影（ERCP）操作困难的一个重要因素。我们回顾性评估了使用前视斜角内镜对既往接受毕罗Ⅱ式胃切除术患者的胆管结石进行治疗性ERCP的有效性和安全性。
本研究纳入了1998年1月至2008年2月期间接受ERCP的43例毕罗Ⅱ式胃切除术后胆管结石患者。所有操作均使用前视斜角内镜。在内镜下通过胆道支架引导使用针刀行括约肌切开术。同期共有808例未行胃切除术的胆管结石患者接受ERCP作为对照。
到达十二指肠乳头的成功率为88.4%，平均到达时间为13分钟。在成功到达的病例中，胆管选择性插管成功率和结石完全清除率分别为94.7%和94.6%。并发症发生率为4.7%。在选择性插管成功率、结石完全清除率和并发症发生率方面，与对照组相比无显著差异。
使用前视斜角内镜能够使既往接受毕罗Ⅱ式胃切除术的患者在胆管选择性插管和结石完全清除方面获得较高成功率。对这些患者进行治疗性ERCP清除胆管结石的安全性与解剖结构正常的患者相当。
