Case Report
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World J Gastroenterol. Jan 14, 2014; 20(2): 607-610
Published online Jan 14, 2014. doi: 10.3748/wjg.v20.i2.607
ERCP for patients who have undergone Billroth II gastroenterostomy and Braun anastomosis
Wen-Guang Wu, Jun Gu, Wen-Jie Zhang, Ming-Ning Zhao, Ming Zhuang, Yi-Jing Tao, Ying-Bin Liu, Xue-Feng Wang
Wen-Guang Wu, Jun Gu, Wen-Jie Zhang, Ming-Ning Zhao, Ming Zhuang, Ying-Bin Liu, Xue-Feng Wang, Laboratory of General Surgery and Department of General Surgery, Xinhua Hospital, Affiliated to Shanghai Jiao Tong University, School of Medicine, Shanghai 200092, China
Wen-Guang Wu, Jun Gu, Wen-Jie Zhang, Ming-Ning Zhao, Ming Zhuang, Ying-Bin Liu, Xue-Feng Wang, Institute of Biliary Tract Disease, Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China
Yi-Jing Tao, Department of Clinical Nutrition, Xinhua Hospital, Affiliated to Shanghai Jiao Tong University, School of Medicine, Shanghai 200092, China
Author contributions: Wu WG, Gu J and Wang XF designed research; Wu WG, Gu J and Wang XF performed research; Zhang WJ and Zhao MN contributed new reagents or analytic tools; Zhuang M, Tao YJ and Liu YB analyzed data; Wu WG, Gu J and Wang XF wrote the paper; Wu WG and Gu J contributed equally to this work.
Supported by Shanghai Education Commission Scientific Research and Innovation Project, No. 11YZ55
Correspondence to: Xue-Feng Wang, MD, Laboratory of General Surgery and Department of General Surgery, Xinhua Hospital, Affiliated to Shanghai Jiao Tong University, School of Medicine, No. 1665 Kongjiang Road, Shanghai 200092, China. wxxfd@live.cn
Telephone: +86-21-25076880 Fax: +86-21-25076880
Received: September 13, 2013
Revised: November 21, 2013
Accepted: December 3, 2013
Published online: January 14, 2014
Processing time: 128 Days and 0.7 Hours
Abstract

Endoscopic retrograde cholangiopancreatography (ERCP) is efficacious in patients who have undergone Billroth II gastroenterostomies, but the success rate decreases in patients who also have experienced Braun anastomoses. There are currently no reports describing the preferred enterography route for cannulation in these patients. We first review the patient’s previous surgery records, which most often indicate that the efferent loop is at the greater curvature of the stomach. We recommend extending the duodenoscope along the greater curvature of the stomach and then advancing it through the “lower entrance” at the site of the gastrojejunal anastomosis, along the efferent loop, and through the “middle entrance” at the site of the Braun anastomosis to reach the papilla of Vater. Ten patients who had each undergone Billroth II gastroenterostomy and Braun anastomosis between January 2009 and December 2011 were included in our study. The overall success rate of enterography was 90% for the patients who had undergone Billroth II gastroenterostomy and Braun anastomosis, and the therapeutic success rate was 80%. We believe that this enterography route for ERCP is optimal for a patient who has had Billroth II gastroenterostomy and Braun anastomosis and helps to increase the success rate of the procedure.

Keywords: Optimal enterography route; Endoscopic retrograde cholangiopancreatography; Billroth II; Gastroenterostomy; Braun anastomosis

Core tip: We recommend extending the duodenoscope along the greater curvature of the stomach and then advancing it through the “lower entrance” at the site of the gastrojejunal anastomosis, along the efferent loop, and through the “middle entrance” at the site of the Braun anastomosis to reach the papilla of Vater. We believe that this enterography route for endoscopic retrograde cholangiopancreatography is optimal for a patient who has undergone Billroth II gastroenterostomy and Braun anastomosis and helps to increase the success rate of the procedure.