Clin Endosc.  2020 Jan;53(1):82-89. 10.5946/ce.2019.073.

Experience of the Endoscopists Matters in Endoscopic Retrograde Cholangiopancreatography in Billroth II Gastrectomy Patients

• Caglar E
• Atasoy D
• Tozlu M
• Altınkaya
• Dogan S
• Senturk H

• KMID: 2500909
• DOI: http://doi.org/10.5946/ce.2019.073

Abstract

Background/Aims
Altered anatomy is a challenge in endoscopic retrograde cholangiopancreatography (ERCP) for patients with Billroth II anastomosis. In this study, we investigated the overall success and role of endoscopist experience.
Methods
Data of patients who underwent ERCP between 2014 and 2018 after a previous Billroth II operation were retrieved retrospectively from 2 tertiary ERCP centers. The procedures were performed by 2 endoscopists with different levels of experience. Clinical success was defined as extraction of the stone, placement of a stent through a malignant stricture, and clinical and laboratory improvements in patients.
Results
Seventy-five patients were included. The technical success rate was 83% for the experienced endoscopist and 75% for the inexperienced endoscopist (p=0.46). The mean (±standard deviation) procedure time was 23.8±5.7 min for the experienced endoscopist and 40.68±6.07 min for the inexperienced endoscopist (p<0.001). In total, 3 perforations (4%) were found. The rate of afferent loop perforation was 6.25% (1/16) for the inexperienced endoscopist and 0% (0/59) for the experienced endoscopist (p=0.053).
Conclusions
ERCP in patients who had undergone Billroth II gastrectomy was time consuming for the inexperienced endoscopist who should beware of the unique adverse events related to ERCP in patients with altered anatomy.

Keyword

Gastrectomy; Endoscope; Endoscopic retrograde cholangiopancreatography; Complication

Figure

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  Fig. 1. Flowchart of the 75 patients who underwent Billroth II gastrectomy. PTC, percutaneous transhepatic cholangiography.

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  Fig. 2. (A) U-shaped appearance of the endoscope under fluoroscopy. (B) Retroverted appearance of the papilla in a patient who had undergone Billroth II gastrectomy.

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  Fig. 3. (A) Cannulation and contrast injection, (B) dilatation of malignant stricture with a 10-mm balloon, (C) placement of a 10-F 10-cm plastic stent through the stricture in a patient with cholangiocarcinoma in the main hepatic channel (Bismuth type I) who had undergone Billroth II gastrectomy.

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  Fig. 4. Success and complication rates (%) of the experienced and inexperienced endoscopists.

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  Fig. 5. Endoscopic retrograde cholangiopancreatography durations in patients who had undergone Billroth II gastrectomy by the experienced and inexperienced endoscopists.

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