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Endoscopic access to the papilla of Vater for endoscopic retrograde cholangiopancreatography in patients with billroth II or Roux-en-Y gastrojejunostomy.
Endoscopy. 1997 Feb; 29(2):69-73.E

Abstract

BACKGROUND AND STUDY AIMS

Endoscopic retrograde cholangiopancreatography (ERCP) is an established modality for the diagnosis and treatment of pancreaticobiliary disorders. In contrast to ERCP in patients who have not undergone gastrectomy, ERCP in patients with a Billroth II gastrojejunostomy or a Roux-en-Y anastomosis is considerably more difficult. It was nevertheless considered that ERCP might be possible in most patients with gastrectomies, and this hypothesis was tested.

PATIENTS AND METHODS

A total of 2256 patients were admitted to our hospital for ERCP from 1990 to 1994. Of these, 65 (3%) had gastrojejunostomies, either with Billroth II reconstructions or with the Roux-en-Y procedure. ERCP was always performed with a conventional side-viewing endoscope.

RESULTS

We examined the 65 patients with gastrojejunostomies. Of these, 91% had Billroth II anastomoses and 9% had received Roux-en-Y reconstructions. We successfully reached the papilla of Vater with the endoscope in 92% of the patients with Billroth II gastrojejunostomies (54 of 59), but in only 33% of the patients with Roux-en-Y reconstructions (two of six). In 8% of the cases of Billroth II anastomosis, it was not possible to advance the endoscope into the duodenal stump, due to intestinal stenoses (5%) or excessive intestinal length (3%). Failure in case of regular Billroth II anatomy occurred only in patients who had not received Braun enteroenterostomies. Failure also occurred in 67% of the Roux-en-Y gastrojejunostomy cases due to excessive intestinal length.

CONCLUSIONS

Most patients with Billroth II gastrojejunostomy (92% of those in the present study) and some patients with Roux-en-Y anastomosis (33% of those in the present study) can be investigated by ERCP and endoscopically treated in cases of pancreaticobiliary disorder. Braun enteroenterostomy has no negative impact on the endoscopic access to the papilla of Vater in patients with Billroth II gastrojejunostomy. Surgical reconstruction of the gastrointestinal tract to perform gastrojejunostomy should also take endoscopic requirements into account. In view of both the potential postoperative complications and endoscopic requirements, the jejunojejunostomy should be placed nearer to the gastrojejunostomy than 60 cm, and the afferent loop should be as short as possible.

Authors+Show Affiliations

Dept. of Internal Medicine and Gastroenterology, Humboldt University, Berlin, Germany.No affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

9101141

Citation

Hintze, R E., et al. "Endoscopic Access to the Papilla of Vater for Endoscopic Retrograde Cholangiopancreatography in Patients With Billroth II or Roux-en-Y Gastrojejunostomy." Endoscopy, vol. 29, no. 2, 1997, pp. 69-73.
Hintze RE, Adler A, Veltzke W, et al. Endoscopic access to the papilla of Vater for endoscopic retrograde cholangiopancreatography in patients with billroth II or Roux-en-Y gastrojejunostomy. Endoscopy. 1997;29(2):69-73.
Hintze, R. E., Adler, A., Veltzke, W., & Abou-Rebyeh, H. (1997). Endoscopic access to the papilla of Vater for endoscopic retrograde cholangiopancreatography in patients with billroth II or Roux-en-Y gastrojejunostomy. Endoscopy, 29(2), 69-73.
Hintze RE, et al. Endoscopic Access to the Papilla of Vater for Endoscopic Retrograde Cholangiopancreatography in Patients With Billroth II or Roux-en-Y Gastrojejunostomy. Endoscopy. 1997;29(2):69-73. PubMed PMID: 9101141.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Endoscopic access to the papilla of Vater for endoscopic retrograde cholangiopancreatography in patients with billroth II or Roux-en-Y gastrojejunostomy. AU - Hintze,R E, AU - Adler,A, AU - Veltzke,W, AU - Abou-Rebyeh,H, PY - 1997/2/1/pubmed PY - 1997/2/1/medline PY - 1997/2/1/entrez SP - 69 EP - 73 JF - Endoscopy JO - Endoscopy VL - 29 IS - 2 N2 - BACKGROUND AND STUDY AIMS: Endoscopic retrograde cholangiopancreatography (ERCP) is an established modality for the diagnosis and treatment of pancreaticobiliary disorders. In contrast to ERCP in patients who have not undergone gastrectomy, ERCP in patients with a Billroth II gastrojejunostomy or a Roux-en-Y anastomosis is considerably more difficult. It was nevertheless considered that ERCP might be possible in most patients with gastrectomies, and this hypothesis was tested. PATIENTS AND METHODS: A total of 2256 patients were admitted to our hospital for ERCP from 1990 to 1994. Of these, 65 (3%) had gastrojejunostomies, either with Billroth II reconstructions or with the Roux-en-Y procedure. ERCP was always performed with a conventional side-viewing endoscope. RESULTS: We examined the 65 patients with gastrojejunostomies. Of these, 91% had Billroth II anastomoses and 9% had received Roux-en-Y reconstructions. We successfully reached the papilla of Vater with the endoscope in 92% of the patients with Billroth II gastrojejunostomies (54 of 59), but in only 33% of the patients with Roux-en-Y reconstructions (two of six). In 8% of the cases of Billroth II anastomosis, it was not possible to advance the endoscope into the duodenal stump, due to intestinal stenoses (5%) or excessive intestinal length (3%). Failure in case of regular Billroth II anatomy occurred only in patients who had not received Braun enteroenterostomies. Failure also occurred in 67% of the Roux-en-Y gastrojejunostomy cases due to excessive intestinal length. CONCLUSIONS: Most patients with Billroth II gastrojejunostomy (92% of those in the present study) and some patients with Roux-en-Y anastomosis (33% of those in the present study) can be investigated by ERCP and endoscopically treated in cases of pancreaticobiliary disorder. Braun enteroenterostomy has no negative impact on the endoscopic access to the papilla of Vater in patients with Billroth II gastrojejunostomy. Surgical reconstruction of the gastrointestinal tract to perform gastrojejunostomy should also take endoscopic requirements into account. In view of both the potential postoperative complications and endoscopic requirements, the jejunojejunostomy should be placed nearer to the gastrojejunostomy than 60 cm, and the afferent loop should be as short as possible. SN - 0013-726X UR - https://www.unboundmedicine.com/medline/citation/9101141/Endoscopic_access_to_the_papilla_of_Vater_for_endoscopic_retrograde_cholangiopancreatography_in_patients_with_billroth_II_or_Roux_en_Y_gastrojejunostomy_ L2 - http://www.thieme-connect.com/DOI/DOI?10.1055/s-2007-1004077 DB - PRIME DP - Unbound Medicine ER -