Endoscopic diagnostics and management of pancreatic- biliary disorders in patients after Billroth II gastric resection

Czech version

Authors: Bohuslav Kianička ¹; Petr Dítě ²; P. Piskač ³
Authors‘ workplace: Gastroenterologické oddělení II. interní kliniky Lékařské fakulty MU a FN u sv. Anny Brno, přednosta prof. MU Dr. Miroslav Souček, CSc. ¹; Interní hepatogastroenterologická klinika Lékařské fakulty MU a FN Brno, pracoviště Bohunice, přednosta prof. MU Dr. Jan Lata, CSc. ²; I. chirurgická klinika Lékařské fakulty MU a FN u sv. Anny Brno, přednosta prof. MU Dr. Ivan Čapov, CSc. ³
Published in: Vnitř Lék 2009; 55(11): 1043-1050
Category: Original Contributions

Overview

Aims of the study:
The aim of this retrospective study was to analyse diagnostic and therapeutic success of endoscopic retrograde cholangiopancreatography (ERCP) in our sample of patients following Billroth II gastric resection, where, due to significantly modified anatomic ratios, this surgery represents a specific and often extremely difficult technical problem when performing ERCP. Materials and methodology: The sample was followed up for 13 years (November 1994 – December 2007). The data on 112 patients after Billroth II gastric resection were assessed retrospectively; indications for ERCP included cholestasis in 92 patients, acute biliary pancreatitis in 12 patients, acute cholangitis in 6 patients and suspected bile leak following laparoscopic cholecystectomy (LCE) in 2 patients. Results: Cannulation success during ERCP in the 112 patients following Billroth II gastric resection was 90.2% (i.e. 101 of the 112 patients). Normal ERCP finding was recorded in 4 patients. The remaining 97 patients had pathological results on ERCP (choledocholitiasis was found in 78 patients, malignant biliary stenosis in 14, benign biliary stenosis in 3 a bile leak following LCE in 2). Endoscopic treatment was initiated immediately after diagnostic ERCP in all these 97 patients, the initial step was in all cases endoscopic papillotomy using one of the special papillotomes (diathermy wire). Overall, therapeutic ERCP was completely successful in 83 of the 97 patients (85.6% of 97) in whom the originally endoscopic treatment had been initiated. Conclusions: ERCP following Billroth IIgastric resection is, due to modified post‑surgery anatomy, markedly more challenging then the conventional procedure. Availability of a variety of tools as well as, understandably, extensive experience and skill of an endoscopist are prerequisite to ERCP success in these patients. Correctly performed ERCP in patients following Billroth II gastric resection is a highly effective and safe method for diagnostics and, in particular, treatment of pancreatic- biliary diseases, in which similar success as under standard anatomic conditions can be achieved.

Key words:
endoscopic retrograde cholangiopancreatography – Billroth II gastrectomy – endoscopic papillotomy – endoscopic treatment

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