Published online Aug 21, 2014. doi: 10.3748/wjg.v20.i31.10921
Revised: March 15, 2014
Accepted: April 28, 2014
Published online: August 21, 2014
AIM: To describe an optimal route to the Braun anastomosis including the use of retrieval-balloon-assisted enterography.
METHODS: Patients who received a Billroth II gastroenterostomy (n = 109) and a Billroth II gastroenterostomy with Braun anastomosis (n = 20) between January 2009 and May 2013 were analyzed in this study. Endoscopic retrograde cholangiopancreatography (ERCP) was performed under fluoroscopic control using a total length of 120 cm oblique-viewing duodenoscope with a 3.7-mm diameter working channel. For this procedure, we used a triple-lumen retrieval balloon catheter in which a 0.035-inch guidewire could be inserted into the “open-channel” guidewire lumen while the balloon could be simultaneously injected and inflated through the other 2 lumens.
RESULTS: For the patients with Billroth II gastroenterostomy and Braun anastomosis, successful access to the papilla was gained in 17 patients (85%) and there was therapeutic success in 16 patients (80%). One patient had afferent loop perforation, but postoperative bleeding did not occur. For Billroth II gastroenterostomy, there was failure in accessing the papilla in 15 patients (13.8%). ERCP was unsuccessful because of tumor infiltration (6 patients), a long afferent loop (9 patients), and cannulation failure (4 patients). The papilla was successfully accessed in 94 patients (86.2%), and there was therapeutic success in 90 patients (82.6%). Afferent loop perforation did not occur in any of these patients. One patient had hemorrhage 2 h after ERCP, which was successfully managed with conservative treatment.
CONCLUSION: Retrieval-balloon-assisted enterography along an optimal route may improve the ERCP success rate after Billroth II gastroenterostomy and Braun anastomosis.
Core tip: For patients with a Billroth II gastroenterostomy, endoscopic retrograde cholangiopancreatography (ERCP) is difficult because of altered anatomy, and the success rate decreases for those with Braun anastomosis. ERCP failure in such patients is caused by difficulties in entering the afferent loop and accessing the papilla. We reported the use of a wire-guided retrieval balloon to remove common bile duct stones and facilitate endoscope insertion for successful ERCP in post-gastrointestinal surgery patients. We termed the procedure “retrieval-balloon-assisted enterography”. We believe that retrieval-balloon-assisted enterography along the optimal route may improve the ERCP success rate after Billroth II gastroenterostomy and Braun anastomosis.