Prostheses Protected Sphincterotomy - A Safe Way For Therapeutic Ercp In Billroth Ii-Patients

Endoscopic sphincterotomy (EST) is difficult in patients who have undergone partial gastrectomy with Billroth II anastomoses. This study describes our experience using prostheses protected sphincterotomy in Billroth II patients. Methods: Prospective Study of 729 patients with Billroth II anastomoses undergoing ERCP including therapeutic interventions between 01/88-12/04. Details noted included indications for ERCP, therapeutic interventions, causes of failure and complications. Results: Success rate of diagnostic ERCP was 75,8% (553/729). Major indications for ERCP were common bile duct stones (52%), jaundice of unknown origin (19%), chronic pancreatitis (9%) and malignant tumors (9%). Interventional endoscopy was performed in 271 patients. Since 1993 we performed prostheses protected sphincterotomy . In comparison to conventional EST we could increase the efficiency of EST from 92,6% (1988-1992, n = 95) to 96,8% (1993-2004; n = 189). Complete extraction of bile duct stones was achieved in 79,3% (249/314;1988-1992 73,5%, n = 83; 1993-2004 81,4%, n = 231). Sufficient bile drainage was achieved by placement of transpapillary endoprostheses in 98% (183/186). The overall complication rate was 5,1% (37/729). The major complication of the procedure was perforation (1,8%, 1/729). 8 perforations occurred in the small bowel while the endoscope was being manipulated through the afferent loop, 5 patients had retroduodenal perforations. 9 patients suffered from bleeding after sphincterotomy (9/314 , 2,9%), 8 (1,1%) patient developed acute pancreatitis and 7 (1%) patients acute cholangitis. Conclusion: Prostheses protected sphincterotomy is a safe and useful technique in treatment of biliary obstructions in Billroth II patients. It can increase the success rate and reduce potential risks.