Endoscopic retrograde cholangiopancreatography and needle-knife sphincterotomy in patients with Billroth II gastrectomy: a comparative study of the forward-viewing endoscope and the side-viewing duodenoscope.

BACKGROUND AND STUDY AIMS: A prospective, randomized study was carried out to compare the success and complication rates associated with the forward-viewing endoscope and side-viewing duodenoscope in conducting endoscopic retrograde cholangiopancreatography (ERCP) and needle-knife sphincterotomy in patients with a Billroth II gastrectomy.

PATIENTS AND METHODS: The study included 45 patients with a Billroth II gastrectomy who required ERCP and endoscopic sphincterotomy (EST) for evaluation and management of pancreaticobiliary disease. The patients were randomly assigned to receive ERCP and EST with either a forward-viewing endoscope or a side-viewing duodenoscope.

RESULTS: Cannulation of the papilla was successful in 68% (15 of 22) in the side-viewing duodenoscope group, and in 87% (20 of 23) in the forward-viewing endoscope group. Failures of cannulation occurred in seven patients in the side-viewing duodenoscope group, caused by jejunal perforation during insertion (n = 4), by a long afferent loop (n = 1), by a complaint of severe abdominal pain (n = 1), and by failure to enter the afferent loop (n = 1). In the forward-viewing endoscope group, failure occurred in three patients due to the long afferent loop (n = 2) and to an inability to cannulate despite identification of the papilla (n = 1). Sphincterotomy was successfully completed in eight of ten patients (80%) in the side-viewing duodenoscope group, and in ten of twelve patients (83%) in the forward-viewing endoscope group.

CONCLUSIONS: For ERCP and EST in patients with Billroth II gastrectomy, the forward-viewing endoscope is as effective as the side-viewing duodenoscope, but it may be the safer of the two instruments. The forward-viewing endoscope can be recommended for ERCP and EST in patients with a Billroth II gastrectomy.