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KMID : 0359020100410060344
Korean Journal of Gastrointestinal Endoscopy
2010 Volume.41 No. 6 p.344 ~ p.349
Cap-assisted ERCP in Surgically Altered Anatomy
Park Eun-Seo

Lee Tae-Hoon
Park Sang-Heum
Ko Gyu-Bong
Son Bum-Suk
Shim Yun-Suk
Lee Sae-Hwan
Kim Hong-Soo
Kim Sun-Joo
Abstract
Backgrounds/Aims: Endoscopic retrograde cholangiopancreatography (ERCP) is a difficult procedure to perform on patients who have undergone a Billroth II gastrectomy, Whipple’s operation or Roux-en-Y gastrobypass surgery. Our study was designed to evaluate the clinical usefulness of cap-assisted ERCP for beginner endoscopists in cases of surgically altered anatomy.

Methods: From April 2008 to March 2010, 16 patients with biliary diseases and who had previously undergone abdominal surgery such as Billroth II gastrectomy or Roux-en-Y operation were analyzed. A single endoscopist performed all the procedures using a cap-assisted gastroscope, after ERCP training.

Results: Cap-assisted ERCP was attempted in 24 sessions of 16 patients. Afferent loop intubation and selective bile duct cannulation was successfully achieved in 19 sessions (79.1%). Among the patients who had undergone a Billroth II gastrectomy, 19 out of 20 sessions were successfully conducted. Only 4 patients who had undergone a previous Roux-en-Y operation failed afferent loop intubation. Duodenal free wall perforation developed in one case. There were no cases of mortality.

Conslusions: Therapeutic cap-assisted ERCP was useful in patients who had previously undergone a Billroth II gastrectomy and this may be helpful for inexperienced endoscopists.
KEYWORD
ERCP, Cap-assisted ERCP, Billroth II, Roux-en-Y anastomosis
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