Outcomes of ERCP in Billroth II gastrectomy patients

Background and Aims: ERCP is a difficult procedure to perform in Billroth II gastrectomy patients because of altered anatomy. We investigated the outcomes and risk factors for adverse events with ERCP using a cap-fitted forward-viewing endoscope with endoscopic papillary balloon dilation (EPBD) in Billroth II gastrectomy patients. Methods: The records for Billroth II gastrectomy patients who underwent ERCP using a cap-fitted forward-viewing endoscope with EPBD at 5 institutions between August 2008 and April 2014 were retrospectively reviewed. The outcomes and risk factors for adverse events resulting from this treatment were analyzed. Results: In total, 165 patients were identified. ERCP was technically successful in 144 patients (87.3%) and clinically successful in 141 patients (85.5%). Adverse events occurred in 38 patients (23.0%): perforation in 3 cases (1.8%), pancreatitis in 13 cases (7.9%), and asymptomatic hyperamylasemia in 22 patients (13.3%). In univariate analysis, >= 2 ERCP sessions, periampullary diverticulum, and common bile duct (CBD) stone size >= 12 mm were found to be associated with ERCP-related adverse events. In multivariate analysis, >= 2 ERCP sessions (odds ratio [OR], 4.762; 95% confidence interval [CI], 1.472-15.402; P = .009) and a CBD stone size >= 12 mm (OR, 3.213; 95% CI, 1.140-9.057; P = .027) were significant. Conclusions: ERCP using a cap-fitted forward-viewing endoscope with EPBD is feasible in Billroth II gastrectomy patients. In patients with >= 2 ERCP sessions or a CBD stone size >= 12 mm, special attention should be paid to the possible occurrence of significant adverse events.