Endoscopic retrograde cholangiopancreatography (ERCP) in patients with prior Billroth II gastrectomy is a challenging procedure for the endoscopist. The aim of this study was to evaluate the usefulness of the conventional side-viewing duodenoscope for ERCP in Billroth II gastrectomy patients.Methods
The records of patients with previous Billroth II gastrectomy referred for ERCP between July 2008, and January 2017 were retrospectively reviewed. The outcomes combined with risk factors for ERCP-related adverse events were analysed.Results
A total of 106 consecutive patients undergoing 123 ERCP procedures using a conventional side-viewing duodenoscope were enrolled. The success rate of the selective entrance to the afferent loop and access to the papilla was 93%, 89%, respectively. In cases of successful access, the rate of successful selective cannulation was 96.6%. The rate of clinical success was 84%. Adverse events related to ERCP occurred in 20 procedures (16.2%): pancreatitis, asymptomatic hyperamylasemia, perforation and cholangitis were in 6 procedures (4.9%), 11 procedures (8.9%), 1 procedures (0.8%), 2 procedures (1.6%), respectively. Female (odds ratio [OR], 4.210; 95% confidence interval [CI], 1.581–11.214; p=0.004) and periampullary diverticulum (OR, 4.373; 95% CI, 1.713–11.164; p=0.002) were significantly associated with the incidence of ERCP-related adverse events.Conclusions
The conventional side-viewing duodenoscope can be safely and effectively used to perform ERCP in most Billroth II gastrectomy patients. Female and periampullary diverticulum might be significant risk factors for ERCP-related adverse events.