Diagnosis and treatment of malignant and non-malignant pancreatobiliary diseases using ERCP in patients with Billroth II gastrectomy: A 13-year retrospective analysis.

Introduction and aim of the study: The aim of this retrospective study was an analysis of the success rate of diagnostic and therapeutic endoscopic retrograde cholangiopancreatography (ERCP) in a group of patients with pancreatobiliary malignancies and other pancreatobiliary diseases. These patients had undergone Billroth II gastrectomy, which posed a specific and very difficult technical problem for ERCP due to the significantly altered anatomical relationships. Material and methods: This study took thirteen years (November 1994 - December 2007). The paper retrospectively assesses 112 patients with Billroth II gastrectomy who underwent ERCP. Results: The indications for performing ERCP were cholestasis in 92, acute biliary pancreatitis in 12, acute cholangitis in 6, and suspicion of bile leak after laparoscopic cholecystectomy (LCE) in 2 patients. A cannulation success rate of 90.2% (101 of 112 patients) was achieved in performing ERCP in patients with Billroth II gastrectomy. Normal ERCP results were present in 4 patients. ERCP results in the remaining 97 patients were pathological (78 patients were diagnosed with choledocholithiasis, 14 with malignant biliary stenosis, 3 with benign biliary stenosis, and 2 with bile leak after LCE). Endoscopic treatment was undertaken in all of these 97 patients immediately after diagnostic ERCP. Endoscopic papillotomy was always performed as an initial step with the use of special papillotomes. Overall, therapeutic ERCP was absolutely successful in 83 of the 97 patients (85.6%) who were originally treated with endoscopy. Conclusions: ERCP in patients with Billroth II gastrectomy is much more demanding than the standard procedure due to the different postoperative anatomy. ERCP success is determined by the abundance of variable instrumentation and, of course, the personal experience and skill of the endoscopist. ERCP properly performed in patients with Billroth II gastrectomy is a highly effective and safe method of endoscopic diagnostics and treatment of pancreatobiliary malignancies and other pancreatobiliary diseases, The achieved success rate can be almost the same as under normal anatomical conditions. [ABSTRACT FROM AUTHOR]