The utility of a multibending endoscope for selective cannulation during ERCP in patients with a Billroth II gastrectomy (with video)

Abstract

Background: Selective cannulation in patients with a Billroth II gastrectomy is still challenging.

Objective: To evaluate the usefulness of a multibending, forward-viewing endoscope (M-scope) for selective cannulation during diagnostic or therapeutic ERCP in patients with a Billroth II gastrectomy.

Design: Case series.

Setting: Tertiary center.

Patients: Fourteen patients having biliary disease with a Billroth II gastrectomy in whom selective cannulation failed when using a conventional forward-viewing endoscope.

Interventions: In all cases, we attempted selective biliary cannulation for ERCP with a single-bending, forward-viewing endoscope for 10 minutes. After failure with the conventional endoscope, we retried selective cannulation with the M-scope for 10 minutes. After cannulation, the diagnostic or therapeutic endoscopic procedures were performed.

Main outcome measurements: We assessed the success rate of selective cannulation, the possibility of therapeutic approaches, and procedure-related complications.

Results: In all cases, we successfully reached the ampulla of Vater with the M-scope. The overall success rate of selective cannulation with the M-scope was 92.9% (13/14). One patient developed mild pancreatitis. Therapeutic procedures such as sphincterotomy, balloon dilatation, stone removal, and biliary drainage were all possible.

Limitations: Small number of patients; uncontrolled, single-center study.

Conclusions: The M-scope seems to be helpful for selective cannulation during ERCP in patients with a Billroth II gastrectomy. All diagnostic and therapeutic procedures were possible through the M-scope.