Endoscopic pancreaticobiliary procedures in patients with a Billroth II resection: a 10-year follow-up study.

BACKGROUND

Previous gastrectomy may present technical difficulties for the endoscopist, but the problem appears to be decreasing.

AIM

To assess endoscopic retrograde cholangiopancreatography and endoscopic papillotomy in Billroth II patients compared to similar material acquired 10 years ago.

MATERIAL AND METHODS

We compared a five-year series of patients submitted to Billroth II to a similar series at our two hospitals obtained 10 years ago. The techniques applied were mostly unchanged, although stent-assisted needle knife papillotomy was successfully introduced during the last year.

RESULTS

Endoscopic retrograde cholangiopancreatography was successful in 123 out of 138 patients (89%), requiring a total of 206 procedures to complete diagnostic and therapeutic goals. Endoscopic papillotomy was successful in 81 out of 87 cases (93%). Additional procedures were performed in 40 of the patients. Two duodenal perforations occurred. Compared to ten years ago, total numbers were almost unchanged, but the proportion of patients with a therapeutic indication increased from 34% to 63%.

CONCLUSION

There is still need for the special endoscopic retrograde cholangiopancreatography competence that Billroth II anatomy requires, and the special techniques described here should be available in at least some referral endoscopy centres.