| Theme |
Development of Diagnosis and Therapy for Biliary Tract Diseases |
| Title |
Endoscopic Retrograde Cholangiopancreatography for Billroth II and Roux-en-Y Reconstruction Patients |
| Author |
Akio Katanuma |
Center for Gastroenterology, Teine-Keijinkai Hospital |
| Author |
Hiroyuki Maguchi |
Center for Gastroenterology, Teine-Keijinkai Hospital |
| Author |
Shunpei Hashigo |
Center for Gastroenterology, Teine-Keijinkai Hospital |
| Author |
Maki Kaneko |
Center for Gastroenterology, Teine-Keijinkai Hospital |
| Author |
Ryusuke Katou |
Center for Gastroenterology, Teine-Keijinkai Hospital |
| Author |
Ryo Harada |
Center for Gastroenterology, Teine-Keijinkai Hospital |
| [ Summary ] |
Endoscopic retrograde cholangiopancreatography (ERCP) in the surgically altered gastrointestinal tract can present a significant challenge for endoscopists. First, access to the ampulla of Vater may require the endoscopist to traverse a significant length of small intestine. For patients who have undergone a Billroth II gastrojejunostomy, the shortest access route is through the afferent limb. In the case of Billroth Ⅱ anastomosis, the length of bowel which must be traversed can be short and the major papilla is often easily accessible. In contrast, ERCP in Roux-en-Y anastomosis is more challenging. Patients who have undergone a Roux-en-Y anastomosis typically require the use of a long forward-viewing endoscope to access the major papilla for the performance of ERCP. Recently, the utility of double balloon endoscopy has been noted when dealing with cases of Roux-en-Y reconstruction. EST for these patients remains more difficult and challenging than for patients with normal anatomies. Currently, the most accepted technique is needle-knife sphincterotomy over a previously inserted endoprosthesis. Direct visualization of the cutting wire, the presence of a clear guiding stent, and stepwise incision make this technique a well-controlled and safer procedure than nonguided techniques. |