Background and Aims
ERCP is a difficult procedure to perform in Billroth II gastrectomy patients because
of altered anatomy. We investigated the outcomes and risk factors for adverse events
with ERCP using a cap-fitted forward-viewing endoscope with endoscopic papillary balloon
dilation (EPBD) in Billroth II gastrectomy patients.
Methods
The records for Billroth II gastrectomy patients who underwent ERCP using a cap-fitted
forward-viewing endoscope with EPBD at 5 institutions between August 2008 and April
2014 were retrospectively reviewed. The outcomes and risk factors for adverse events
resulting from this treatment were analyzed.
Results
In total, 165 patients were identified. ERCP was technically successful in 144 patients
(87.3%) and clinically successful in 141 patients (85.5%). Adverse events occurred
in 38 patients (23.0%): perforation in 3 cases (1.8%), pancreatitis in 13 cases (7.9%),
and asymptomatic hyperamylasemia in 22 patients (13.3%). In univariate analysis, ≥2
ERCP sessions, periampullary diverticulum, and common bile duct (CBD) stone size ≥
12 mm were found to be associated with ERCP-related adverse events. In multivariate
analysis, ≥2 ERCP sessions (odds ratio [OR], 4.762; 95% confidence interval [CI],
1.472-15.402; P = .009) and a CBD stone size ≥ 12 mm (OR, 3.213; 95% CI, 1.140-9.057; P = .027) were significant.
Conclusions
ERCP using a cap-fitted forward-viewing endoscope with EPBD is feasible in Billroth
II gastrectomy patients. In patients with ≥2 ERCP sessions or a CBD stone size ≥ 12 mm,
special attention should be paid to the possible occurrence of significant adverse
events.
Abbreviations:
CBD (common bile duct), CI (confidence interval), EPBD (endoscopic papillary balloon dilation), EST (endoscopic sphincterotomy), OR (odds ratio)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: November 04, 2015
Accepted:
October 25,
2015
Received:
June 9,
2015
Footnotes
DISCLOSURE: All authors disclosed no financial relationships relevant to this publication.
If you would like to chat with an author of this article, you may contact Dr Song at [email protected]
Identification
Copyright
Copyright © 2016 by the American Society for Gastrointestinal Endoscopy
