Objective: Endoscopic retrograde cholangiopancreatography (ERCP) in patients who have undergone Billroth II gastroenterostomy (B-II GE) has been challenging, requiring flexibility in technical approaches during execution. The study aims to assess the effectiveness of enhanced techniques in performing ERCP on this patient group in Vietnam.
Method: A total of 42 Vietnamese patients with B-II GE performed an ERCP using a duodenoscope or a modification of ERCP equipment (a cap-fitted regular forward-viewing endoscope) if the former failed. The effectiveness and safety of the ERCP technique were assessed, particularly in patients who underwent the forward-viewing endoscope method.
Result: A total of 39 out of 42 patients had the Vater's papilla identified, among whom 12 patients (30.8%) achieved successful cannulation into the bile duct using a side-viewing endoscope, significantly lower than the success rate using a forward-viewing endoscope (25/27, counted 92.6%, with p < 0.001). After successful cannulation, the rate of stone clearance, the procedural time, and the hospitalization duration of the patients were equivalent between the two methods and were not dependent on the number or size of the stones. On the other hand, post-ERCP complications in patients utilizing forward-viewing endoscopy included acute pancreatitis (22.2%), post-sphincterotomy bleeding (3.7%), septicemia (4.8%), and perforation (0%). These complications were mild and amenable to conservative endoscopic and medical management, and no mortality was observed. The rates of complications and adverse events after ERCP are comparable between the two treatment methods, even though the end-viewing endoscope is used after the failure of the side-viewing endoscope.
Conclusion: Alter ERCP utilizing a cap-fitted forward-viewing endoscope can be a primary choice for treating common bile duct stones in patients with a Billroth II gastric resection history because of high efficacy and acceptable complications. It requires a high level of procedural expertise that requires multiple training sessions.
Keywords: Billroth II gastroenterostomy; cap-fitted forward-viewing endoscope; common bile duct stone; modification in ERCP.
The promising change in the treatment approach for common bile duct stones in Vietnamese patients with a history of Billroth II gastrectomy Endoscopic retrograde cholangiopancreatography (ERCP) treating common bile duct stones in Vietnamese patients with a history of Billroth II gastrectomy is challenging due to changes in gastric anatomy and the limited visibility of the side-viewing endoscope. The researchers tried different techniques, including using a special type of forward-viewing endoscope with cap assistance. We found that using a forward-viewing endoscope was more successful in reaching certain areas compared to a side-viewing one. Although there were some complications, they were manageable, and the overall results were similar between the two methods. The study suggests that using a modified approach with a forward-viewing endoscope with cap assistance can be a good option for treating common bile duct stones in patients with a history of Billroth II gastric resection, but it requires skilled practitioners.
© The Author(s), 2024.