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Endoscopy. 1997 Feb;29(2):74-8.

Endoscopic sphincterotomy using an S-shaped sphincterotome in patients with a Billroth II or Roux-en-Y gastrojejunostomy.

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1
Dept. of Internal Medicine and Gastroenterology, Virchow Clinic, Humboldt University of Berlin, Germany.

Abstract

BACKGROUND AND STUDY AIMS:

Some patients admitted for endoscopy present a gastrojejunostomy with a Billroth II anastomosis or Roux-en-Y reconstruction. The gastrointestinal reconstruction hampers endoscopic diagnosis and treatment of the biliary and pancreatic tract. The present paper describes a new procedure facilitating endoscopic retrograde cholangiopancreatography (ERCP) in patients who have undergone gastrojejunostomy.

PATIENTS AND METHODS:

ERCP was attempted in 65 patients with gastrojejunostomy. A conventional side-viewing endoscope was advanced into the duodenal stump, and a modified catheter was pushed through the endoscope. The cutting wire of the modified catheter winds round the catheter at a pivotal point between the catheter's proximal and distal holes. This allows the catheter tip to be forced into an S-shape when the wire is pulled. Since the cutting wire can easily be adjusted to the papillary roof, safe and successful endoscopic sphincterotomy can be carried out.

RESULTS:

We were able to advance the conventional side-viewing endoscope into the duodenal stump in 92% of the patients (n = 59) with Billroth II gastrojejunostomies, and in 33% of the patients (n = 6) with Roux-en-Y anastomoses. Whenever it was possible to reach the duodenal stump, cannulation and sphincterotomy of the papilla of Vater was successful. Ninety-six percent of the patients who underwent sphincterotomy (n = 54) immediately benefited from biliary decompression. One major complication occurred, with a patient suffering a retroperitoneal perforation during endoscopic sphincterotomy; the patient later died, despite three subsequent surgical operations.

CONCLUSIONS:

In spite of previous gastrojejunostomy, most patients with Billroth II anastomoses (92%) and many patients with Roux-en-Y reconstructions (33%) can be treated endoscopically for biliary diseases. The use of a conventional side-viewing endoscope in conjunction with an S-shaped sphincterotome can be recommended. This allows safe and successful endoscopic treatment of all patients in whom endoscopic access to the papilla of Vater is possible.

PMID:
9101142
DOI:
10.1055/s-2007-1004078
[Indexed for MEDLINE]
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