Saudi Journal of Gastroenterology
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Endoscopic retrograde cholangiopancreatography in Billroth II gastrectomy patients: Outcomes and potential factors affecting technical failure


1 Department of Gastroenterology, Changhai Hospital, Second Military Medical University, Shanghai, China
2 Digestive Endoscopy Center, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China

Correspondence Address:
Feng Liu,
Digestive Endoscopy Center, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Middle Yanchang Road No. 301, Shanghai 200072
China
Zhao-Shen Li,
Department of Gastroenterology, Changhai Hospital, Second Military Medical University, 168 Changhai Road, Shanghai 200433
China
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/sjg.SJG_118_19

PMID: 31187782

Background/Aims: Endoscopic retrograde cholangiopancreatography (ERCP) in Billroth II gastrectomy patients is technically demanding and factors affecting its technical difficulty have not yet been clarified. This study aimed to investigate the outcomes of ERCP in Billroth II gastrectomy patients and identify potential factors affecting its technical failure. Patients and Methods: A large retrospective study of 308 consecutive patients (391 procedures) with Billroth II gastrectomy—who underwent ERCP from January 2002 to December 2016—was conducted. The outcomes of ERCP and potential factors affecting its technical failure were analyzed. Results: The success rate of duodenal ampullary access, selective duct cannulation and the accomplishment of expected procedures was 81.3% (318/391), 86.5% (275/318) and 97.3% (256/263), respectively, and the technical success rate was 70.3% (275/391). The overall ERCP-related complication rate was 15.3% (60/391). The multivariate analysis indicated that first-time ERCP attempt [odds ratio (OR) 4.29, 95% confidence interval (CI) 2.34–7.85, P < 0.001], Braun anastomosis (OR 3.65, 95% CI 1.38–9.64, P < 0.009), and no cap-assisted gastroscope (OR 3.05, 95% CI 1.69–5.51, P < 0.001) were significantly associated with technical failure. Conclusions: ERCP is safe, effective and feasible for Billroth II gastrectomy patients. Previous ERCP history, absence of Braun anastomosis and the use of a cap-assisted gastroscope are the predictive factors for its technical success.


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