Difficult Factor of Endoscopic Retrograde Cholangiopancreatography for Patients after Billroth II Gastrectomy and Adequate Selection of Endoscope

Endoscopic retrograde cholangiopancreatography (ERCP) is a difficult procedure to perform in patients who have undergone Billroth II gastrectomy (B II) . The aims of the present study were to investigate the effect of Braun's anastomosis (BA) on the performance of ERCP and to determine whether the forward-viewing endoscope or side-viewing duodenoscope is the optimal endoscope for performing ERCP in patients who have undergone B II. This was a retrospective review of 52 ERCP procedures conducted in 45 patients who had B II between April 1996 and March 2007. Indications for ERCP included common bile duct stones (N =36; 80%) and tumor stenosis (N = 9 ; 20%) . The success rate for endoscopic approach to the papilla of Vater was significantly higher in those patients without Braun's anastomosis than with Braun's anastomosis (P < 0.0001) . In addition, therapeutic ERCP was performed successfully in more patients without BA than with BA (P=0.0016) . The forward-viewing endoscope was superior to the side-viewing duodenoscope for approaching the papilla of Vater in patients (P = 0.0023) ; however, there was no significant difference between the two types of endoscope for successful therapeutic ERCP (P = 0.2621) . Braun's anastomosis increased the difficulty of performing ERCP using either endoscope and is a major obstacle to conducting ERCP in patients who have undergone B II. The forward-viewing endoscope is preferable for successful ERCP in these patients.