Endoscopy 2009; 41(10): 902-906
DOI: 10.1055/s-0029-1215087
Case report

© Georg Thieme Verlag KG Stuttgart · New York

Techniques to facilitate ERCP with a conventional endoscope in patients with previous pancreatoduodenectomy

M.  Matsushita1 , H.  Takakuwa2 , K.  Uchida1 , A.  Nishio1 , K.  Okazaki1
  • 1Third Department of Internal Medicine, Kansai Medical University, Osaka, Japan
  • 2Department of Gastroenterology, Tenri Hospital, Nara, Japan
Further Information

Publication History

submitted 19 January 2009

accepted after revision 9 July 2009

Publication Date:
11 September 2009 (online)

There is little guidance on the performance of endoscopic retrograde cholangiopancreatography (ERCP) in patients with previous pancreatoduodenectomy. We reviewed techniques for ERCP with a conventional endoscope and assessed its value in 10 patients with previous pancreatoduodenectomy (15 ERCPs). After exploration of the surgical reconstruction, we used a front-viewing endoscope, and we used a small firm pillow under the abdomen and hand compression for preventing loop formation. Successful insertion to the ductal anastomoses and biliary cannulation were achieved in 13 / 15 procedures (87 %). In 6 procedures where we attempted pancreatic cannulation, we could not identify the pancreatojejunostomy, but after spraying contrast around the suspected location of the ductal anastomosis we obtained a pancreatogram in 4 / 6 procedures (67 %). Endoscopic biliary interventions were successful in 6 / 7 procedures (86 %). No complications were encountered. Use of appropriate techniques makes ERCP with a conventional endoscope feasible, effective, and safe in patients with previous pancreatoduodenectomy. Endoscopic therapy can be performed successfully in the bile duct, but has limited value regarding the pancreatic duct.

References

  • 1 Feitoza A B, Baron T H. Endoscopy and ERCP in the setting of previous upper GI tract surgery. Part II: postsurgical anatomy with alteration of the pancreaticobiliary tree.  Gastrointest Endosc. 2002;  55 75-79
  • 2 Law N M, Freeman M L. ERCP by using a prototype oblique-viewing endoscope in patients with surgically altered anatomy.  Gastrointest Endosc. 2004;  59 724-728
  • 3 Sugiyama M, Izumisato Y, Ubukata N. et al . Peroral jejunoscopy for treating stenosis of hepaticojejunostomy after pancreatoduodenectomy.  Hepatogastroenterology. 2001;  48 681-683
  • 4 Hintze R E, 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 69-73
  • 5 Chahal P, Baron T H, Topazian M D. et al . Endoscopic retrograde cholangiopancreatography in post-Whipple patients.  Endoscopy. 2006;  38 1241-1245
  • 6 Haber G B. Double balloon endoscopy for pancreatic and biliary access in altered anatomy [with videos].  Gastrointest Endosc. 2007;  66 S47-S50
  • 7 Feitoza A B, Baron T H. Endoscopy and ERCP in the setting of previous upper GI tract surgery. Part I: reconstruction without alteration of pancreaticobiliary anatomy.  Gastrointest Endosc. 2001;  54 743-749
  • 8 Mosca S, Uomo G, Ceglia T. et al . Is it always true that ERCP cannot be carried out in patients with Roux-en-Y gastrojejunostomy?.  Endoscopy. 1998;  30 870
  • 9 Wright B E, Cass O W, Freeman M L. ERCP in patients with long-limb Roux-en-Y gastrojejunostomy and intact papilla.  Gastrointest Endosc. 2002;  56 225-232
  • 10 Elton E, Hanson B L, Qaseem T. et al . Diagnostic and therapeutic ERCP using an enteroscope and a pediatric colonoscope in long-limb surgical bypass patients.  Gastrointest Endosc. 1998;  47 62-67
  • 11 Kim M H, Lee S K, Lee M H. et al . 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.  Endoscopy. 1997;  29 82-85
  • 12 Farrell J, Carr-Locke D, Garrido T. et al . Endoscopic retrograde cholangiopancreatography after pancreaticoduodenectomy for benign and malignant disease: indications and technical outcomes.  Endoscopy. 2006;  38 1246-1249
  • 13 Kozicki I, Bielecki K, Kawalski A. et al . Repeated reconstruction for recurrent benign bile duct stricture.  Br J Surg. 1994;  81 677-679
  • 14 Cotton P B, Lehman G, Vennes J. et al . Endoscopic sphincterotomy complications and their management: an attempt at consensus.  Gastrointest Endosc. 1991;  37 383-393
  • 15 Mönkemüller K, Bellutti M, Neumann H. et al . Therapeutic ERCP with the double-balloon enteroscope in patients with Roux-en-Y anastomosis.  Gastrointest Endosc. 2008;  67 992-996
  • 16 Matsushita M, Shimatani M, Takaoka M. et al . ”Short“ double-balloon enteroscope for diagnostic and therapeutic ERCP in patients with altered gastrointestinal anatomy.  Am J Gastroenterol. 2008;  103 3218-3219
  • 17 Mosca S. Which scope and which technique will enhance the success rate in ERCP for the Billroth II patients?.  Am J Gastroenterol. 2000;  95 553-554
  • 18 Kahaleh M, Hernandez A J, Tokar J. et al . EUS-guided pancreaticogastrostomy: analysis of its efficacy to drain inaccessible pancreatic ducts.  Gastrointest Endosc. 2007;  65 224-230

M. MatsushitaMD 

Third Department of Internal Medicine
Kansai Medical University

2-3-1 Shinmachi
Hirakata, Osaka 573-1191
Japan

Fax: +81-72-804-2061

Email: matsumit@hirakata.kmu.ac.jp

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