Original article
Early complications after endoscopic retrograde cholangiopancreatography in patients with previous Billroth II gastric resection: own experience

Introduction: Diagnostic and therapeutic ERCP procedures are technically challenging in patients with previous BII gastric resection.
Aim: The aim of the study was to analyze indications as well as factors with a potential influence on success and complication rates in patients undergoing ERCP.
Materials and methods: A total of 64 patients with previous BII gastric resection who underwent 72 ERCPs overall between 1 January 2001 and 31 December 2004 were reviewed retrospectively.
Results: Indications for ERCP were choledocholithiasis 50% (36/72 procedures), jaundice 34.7% (25/72), malignant infiltration 13.8% (10/72) and chronic pancreatitis 1.3% (1/72). In 79.1% of ERCP procedures (57/72) sphincterotomy was performed. In 49.1% (28/57) of ERCPs with sphincterotomy choledocholithiasis was detected and total clearance of the ducts was achieved in 67.8% (19/28). Successful drainage of the biliary ducts was accomplished in 64.9% (37/57) of procedures. To achieve patency of the ducts 17 plastic and 6 self-expanding metal stents (SEMS) were implanted. The overall complication rate was 8.3% (8/72). In 5.5% (4/72) perforation of the duodenal wall, in 1.3% (1/72) acute pancreatitis and in 1.3% (1/72) bleeding after sphincterotomy occurred.
Conclusions: ERCP in patients with previous Billroth II gastric resection is a challenging and troublesome procedure but performed by a well-trained and skilled endoscopist is a safe and useful technique in biliary and pancreatic disease treatment.