Sakai Yuji, Tsuyuguchi Toshio, Mikata Rintaro, Sugiyama Harutoshi, Yasui Shin, Miyazaki Masaru, Yokosuka Osamu
Yuji Sakai, Toshio Tsuyuguchi, Rintaro Mikata, Harutoshi Sugiyama, Shin Yasui, Osamu Yokosuka, Department of Gastroenterology and Nephrology, Graduate School of Medicine, Chiba University, Chuou-ku, Chiba City 260-8670, Japan.
World J Gastrointest Endosc. 2017 Mar 16;9(3):127-132. doi: 10.4253/wjge.v9.i3.127.
To examine the utility of endoscopic retrograde cholangiopancreatography (ERCP) on biliopancreatic diseases in the patients with Billroth II-reconstructed stomach.
For 26 cases of biliopancreatic diseases in patients with Billroth II-reconstructed stomach, ERCP was conducted using a straight-view scope or a retrograde oblique-viewing endoscope. All the cases were patients aiming at selective insertion into the bile duct. One patient aimed at diagnosis, and 25 patients aimed at treatment. The cases in which the endoscope reached the duodenal papilla and anastomosis, and insertion into the bile duct became possible, were considered successful.
The rate of reaching the duodenal papilla and anastomosis was 84.7% (22/26 patients). Among the cases without reaching the duodenal papilla and anastomosis, there were 2 in which the endoscope did not pass due to tumor-induced duodenal infiltration. In 1 case, the fiber did not reach the duodenal papilla due to long afferent loop. The success rate of insertion into the bile duct in patients in which the endoscope reached the duodenal papilla and anastomosis was 90.9% (20/22 patients), and the success rate of procedures including treatment was 86.3% (19/22 patients). After treatment, mild cholangitis was observed in 1 patient (4.5%, 1/22 patients) but relieved conservatively. No other accidental symptom was observed.
It was considered that the ERCP for biliopancreatic diseases in patients with Billroth II-reconstructed stomach will become a less invasive, safe and useful examination and treatment approach.
探讨内镜逆行胰胆管造影术（ERCP）在毕Ⅱ式胃重建患者胆胰疾病中的应用价值。
对26例毕Ⅱ式胃重建患者的胆胰疾病进行ERCP检查，使用直视镜或逆行斜视角内镜。所有病例均旨在选择性插入胆管。1例以诊断为目的，25例以治疗为目的。内镜到达十二指肠乳头和吻合口且能够插入胆管的病例视为成功。
到达十二指肠乳头和吻合口的成功率为84.7%（22/26例患者）。在未到达十二指肠乳头和吻合口的病例中，有2例因肿瘤浸润十二指肠导致内镜无法通过。1例因输入袢过长，纤维未到达十二指肠乳头。内镜到达十二指肠乳头和吻合口的患者胆管插入成功率为90.9%（20/22例患者），包括治疗在内的操作成功率为86.3%（19/22例患者）。治疗后，1例患者（4.5%，1/22例患者）出现轻度胆管炎，但经保守治疗后缓解。未观察到其他意外症状。
对于毕Ⅱ式胃重建患者的胆胰疾病，ERCP被认为将成为一种侵入性较小、安全且有用的检查和治疗方法。
