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      Usefulness of Forward-Viewing Endoscope for Endoscopic Retrograde Cholangiopancreatography in Patients with Billroth II Gastrectomy

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          Abstract

          Background/Aims

          Patients undergoing Billroth II (B II) gastrectomy are at higher risk of perforation during endoscopic retrograde cholangiopancreatography (ERCP). We assessed the success rate and safety of forward-viewing endoscopic biliary intervention in patients with B II gastrectomy.

          Methods

          A total of 2,280 ERCP procedures were performed in our institution between October 2008 and June 2011. Of these, forward-viewing endoscopic biliary intervention was performed in 46 patients (38 men and 8 women with B II gastrectomy). Wire-guided selective cannulations of the common bile duct using a standard catheter and guide wire were performed in all patients.

          Results

          The success rate of afferent loop entrance was 42 out of 46 patients (91.3%) and of biliary cannulation after the approach of the papilla was 42 out of 42 patients (100%). No serious complications were encountered, except for one case of small perforation due to endoscopic sphincterotomy site injury.

          Conclusions

          When a biliary endoscopist has less experience and patient volume is low, ERCP with a forward-viewing endoscope is preferred because of its ease and safety in all patients with prior B II gastrectomies. Also, forward-viewing endoscope can be used to improve the success rate of biliary intervention in B II patients.

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          Most cited references25

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          Endoscopic sphincterotomy complications and their management: an attempt at consensus.

          P Cotton, G Lehman, J. Vennes … (1991)
          Despite its relative safety (in comparison with surgery), and undoubted role in many clinical circumstances, biliary sphincterotomy is the most dangerous procedure routinely performed by endoscopists. Complications occur in about 10% of patients; 2 to 3% have a prolonged hospital stay, with a risk of dying. This document is an attempt to provide guidelines for prevention and management of complications, based on a workshop of selected experts, and a comprehensive review of the literature. We emphasize particularly the importance of specialist training, disinfection, drainage, and collaboration with surgical colleagues.
          Article 0 comments Cited 303 times – based on 0 reviews     Review now
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            Biliary sphincterotomy plus dilation with a large balloon for bile duct stones that are difficult to extract.

            Galip Ersoz, Fulya Gunsar, A Ozütemiz … (2003)
            Bile duct stones are still present in 10% to 15% of patients after the application of conventional endoscopic extraction techniques and require additional procedures for duct clearance. In the vast majority of these cases, there are 2 main problems: large stone size (>15 mm) and tapering of distal bile duct. Fifty-eight patients in whom endoscopic sphincterotomy and standard basket/balloon extraction were unsuccessful in the removal of bile duct stones underwent dilation with a 10- to 20-mm diameter (esophageal/pyloric type) balloon at the same session. In 18 patients with tapered distal bile ducts (Group 1), 12- to 18-mm diameter balloon catheters were used to enlarge the orifice. In 40 patients with square, barrel shaped and/or large (>15mm) stones (Group 2), the sphincterotomy orifice was enlarged with 15- to 20-mm diameter balloon catheters. After dilatation, standard basket/balloon extraction techniques were used to remove the stone(s). Stone clearance was successful in 16 patients (89%) in Group 1 and 35 (95%) in Group 2. Complications occurred in 9 (15.5%) patients. Dilation with a large-diameter balloon after endoscopic sphincterotomy is a useful alternative technique in patients with bile duct stones that are difficult to remove with standard methods.
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              Large-diameter biliary orifice balloon dilation to aid in endoscopic bile duct stone removal: a multicenter series.

              Siriboon Attasaranya, Young Cheon, Harsha Vittal … (2008)
              The utility and safety of endoscopic biliary orifice balloon dilation (EBD) for bile duct stone removal (with use of large-diameter balloons) after biliary endoscopic sphincterotomy (BES) is currently not well established. Our purpose was to evaluate the efficacy and complications of BES followed by > or = 12 mm diameter EBD for bile duct stone removal. Retrospective, multicenter series. Five ERCP referral centers in the United States. Patients who underwent attempted removal of bile duct stones by BES followed by EBD with > or = 12 mm diameter dilating balloons were identified by searching the prospectively recorded endoscopic databases from 1999 to 2007. Clinical parameters, endoscopic data, and outcomes were collected and analyzed. One hundred three patients, mean age 70 +/- 17 years (range 23-98 years), with 56 (54%) women, underwent 107 procedures. Eleven patients (11%) had a prior history of acute pancreatitis. Pancreatogram was performed in 15 (14%) patients. Median stone size and median balloon diameter used was 13 mm. Complete stone removal in the first session of EBD was accomplished in 102 (95%) procedures, and mechanical lithotripsy was required in 29 (27%). Six patients (5.4%) had documented procedure-related complications including one patient with severe bleeding and one with severe cystic duct perforation. No acute pancreatitis occurred. EBD with a large-diameter balloon in conjunction with BES for bile duct stone removal is effective and relatively safe. This technique appears to be a reasonable alternative option when standard BES and basket or balloon sweep are inadequate to remove bile duct stones.
              Article 0 comments Cited 32 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): Clin Endosc
                Journal ID (iso-abbrev): Clin Endosc
                Journal ID (publisher-id): CE
                Title: Clinical Endoscopy
                Publisher: The Korean Society of Gastrointestinal Endoscopy
                ISSN (Print): 2234-2400
                ISSN (Electronic): 2234-2443
                Publication date (Print): November 2012
                Publication date (Electronic): 30 November 2012
                Volume: 45
                Issue: 4
                Pages: 397-403
                Affiliations
                Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea.
                Author notes
                Correspondence: Jae Woo Kim. Department of Internal Medicine, Yonsei University Wonju College of Medicine, 20 Ilsan-ro, Wonju 220-701, Korea. Tel: +82-33-741-1229, Fax: +82-33-741-1228, jawkim96@ 123456yonsei.ac.kr
                Article
                DOI: 10.5946/ce.2012.45.4.397
                PMC ID: 3521942
                PubMed ID: 23251888
                SO-VID: a6936db0-02b5-4563-bfc4-ab577011063a
                Copyright © Copyright © 2012 Korean Society of Gastrointestinal Endoscopy
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 13 November 2011
                Date revision received : 17 March 2012
                Date accepted : 29 March 2012
                Categories
                Subject: Original Article

                ScienceOpen disciplines: Radiology & Imaging
                Keywords: endoscopic retrograde cholangiopancreatography,billroth ii gastrectomy,forward-viewing endoscope
                Data availability:
                ScienceOpen disciplines: Radiology & Imaging
                Keywords: endoscopic retrograde cholangiopancreatography, billroth ii gastrectomy, forward-viewing endoscope

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