Endoscopic diagnostics and management of pancreatic- biliary disorders in patients after Billroth II gastric resection

Česká verzia

Authors: Bohuslav Kianička ¹ ; Petr Dítě ² ; P. Piskač ³
Authors place of work: Gastroenterologické oddělení II. interní kliniky Lékařské fakulty MU a FN u sv. Anny Brno, přednosta prof. MU Dr. Miroslav Souček, CSc. ¹; Interní hepatogastroenterologická klinika Lékařské fakulty MU a FN Brno, pracoviště Bohunice, přednosta prof. MU Dr. Jan Lata, CSc. ²; I. chirurgická klinika Lékařské fakulty MU a FN u sv. Anny Brno, přednosta prof. MU Dr. Ivan Čapov, CSc. ³
Published in the journal: Vnitř Lék 2009; 55(11): 1043-1050
Category: Original Contributions

Summary

Aims of the study:
The aim of this retrospective study was to analyse diagnostic and therapeutic success of endoscopic retrograde cholangiopancreatography (ERCP) in our sample of patients following Billroth II gastric resection, where, due to significantly modified anatomic ratios, this surgery represents a specific and often extremely difficult technical problem when performing ERCP. Materials and methodology: The sample was followed up for 13 years (November 1994 – December 2007). The data on 112 patients after Billroth II gastric resection were assessed retrospectively; indications for ERCP included cholestasis in 92 patients, acute biliary pancreatitis in 12 patients, acute cholangitis in 6 patients and suspected bile leak following laparoscopic cholecystectomy (LCE) in 2 patients. Results: Cannulation success during ERCP in the 112 patients following Billroth II gastric resection was 90.2% (i.e. 101 of the 112 patients). Normal ERCP finding was recorded in 4 patients. The remaining 97 patients had pathological results on ERCP (choledocholitiasis was found in 78 patients, malignant biliary stenosis in 14, benign biliary stenosis in 3 a bile leak following LCE in 2). Endoscopic treatment was initiated immediately after diagnostic ERCP in all these 97 patients, the initial step was in all cases endoscopic papillotomy using one of the special papillotomes (diathermy wire). Overall, therapeutic ERCP was completely successful in 83 of the 97 patients (85.6% of 97) in whom the originally endoscopic treatment had been initiated. Conclusions: ERCP following Billroth IIgastric resection is, due to modified post‑surgery anatomy, markedly more challenging then the conventional procedure. Availability of a variety of tools as well as, understandably, extensive experience and skill of an endoscopist are prerequisite to ERCP success in these patients. Correctly performed ERCP in patients following Billroth II gastric resection is a highly effective and safe method for diagnostics and, in particular, treatment of pancreatic- biliary diseases, in which similar success as under standard anatomic conditions can be achieved.

Key words:
endoscopic retrograde cholangiopancreatography – Billroth II gastrectomy – endoscopic papillotomy – endoscopic treatment

Zdroje

1. Vavrečka A et al. Diagnostická a liečebná endoskopia žlčových ciest a pankreasu. Bratislava: Osveta 1988.

2. Urban O, Chalupa J. Cysta choledochu. Vnitř Lék 1996; 42: 418– 419.

3. Keil R, Lochmannová J, Námešný I et al. Řešení benigních stenóz žlučových cest. Miniinvazivní terapie 1998; 3: 33– 35.

4. Keil R. Akutní biliární pankreatitida – endoskopická terapie ano nebo ne? Vnitř Lék 2002; 48: 847– 850.

5. Zbořil V, Cigánková E, Studeník P et al. ERCP v diagnostice a terapii komplikací jaterních transplantací. Čes Slov Gastroent Hepatol 1999; 53: 47– 50.

6. Procházka V, Konečný M, Král V at al. CRCP v diagnostice a léčbě biliárních komplikací laparoskopické cholecystektomie. Čes Slov Gastroent Hepatol 1999; 53: 140– 144.

7. Jurgoš L, Kužela L, Hrušovský Š et al. Gastroenterológia. Bratislava: Veda 2006.

8. Novotný I. Pankreatobiliární terapeutická endoskopie u pacientů geriatrického věku. Čes Ger Rev 2007; 5: 78– 84.

9. Paseka T, Veverková L, Diviš P et al. Mirizziho syndrom s cholecystoduodenální píštělí – vzácná komplikace cholecystolitiázy. Čas Lék Čes 2009; 148: 164– 167.

10. Vlček P, Korbička J, Žák J. Kýly. In: Pafko Pet al (eds). Základy speciální chirurgie. Praha: Galén 2008.

11. Kala Z, Kiss I, Válek V et al. Nádory podjaterní oblasti – diagnostika a léčba. Praha: Grada 2009.

12. Špičák J, Dufek V, Jirásek V et al. ERCP a terapeutická endoskopie po resekci žaludku podle Billrotha II. Endoskopie 1993; 2: 3– 5.

13. Aabakken L, Osnes M, Rosseland A et al. Gastrointestinálna endoskopia. Praha: Maxdorf Jessenius 1999.

14. Costamagna G, Mutignani M, Perri V et al. Diagnostic and therapeutic ERCP in patients with Billroth II gastrectomy. Acta Gastroenterol Belg 1994; 57: 155– 162.

15. Aabakken L, Holthe B, Sandstad O et al. Endoscopic pancreaticobiliary procedures in patients with a Billroth II resection: a 10– ear follow‑up study. Ital J Gastroenterol Hepatol 1998; 30: 301– 305.

16. Hintze RE, Adler A, Veltzke W et al. Endoscopic access to the papilla of Vater for endoscopic retrograde cholangiopancreatography in patients with Billroth II or Roux-en- Y gastrojejunostomy. Endoscopy 1997; 29: 69– 73.

17. Demarquay JF, Dumas R, Buckley MJ et al. Endoscopic retrograde cholangiopancreatography in patients with Billroth II gastrectomy. Ital J Gastroenterol Hepatol 1998; 30: 297– 300.

18. Forbes A, Cotton PB. ERCP and sphincterotomy after Billroth II gastrectomy. Gut 1984; 25: 971– 974.

19. Ricci E, Bertoni G, Conigliaro R et al. Endoscopic sphincterotomy in Billroth II patients: an improved method using a diathermic needle as sphincterotome and a nasobiliary drainage as a guide. Gastrointest Endosc 1989; 35: 47– 50.

20. Wilkinson ML, Engelman JL, Hanson PJ. Intestinal perforation after ERCP in Billroth II partial gastrectomy. Gastrointest Endosc 1994; 40: 389– 390.

21. Zavoral M, Dítě, P, Špičák J et al. Nové trendy v digestivní endoskopické diagnostice a léčbě. Praha: Grada Publishing 2000.

22. Huibregtse K. Difficult cannulation in Billroth II gastrectomy patients. In: Endoscopic biliary and pancreatic drainage. Stuttgart- New York: Thieme Verlag 1988: 54– 58.

23. Rosseland A, Osnes M, Krause A. Endoscopic sphincterotomy (EST) in patients with Billroth II gastrectomy. Endoscopy 1981; 13: 19– 24.

24. Osnes M, Rosseland A, Aabakken L. Endoscopic retrograde cholangiography and endoscopic papillotomy in patients with a previous Billroth II resection. Gut 1986; 27: 1193– 1198.

25. Wang YG, Binmoeller KF, Seifert H et al. A new guide wire papillotome for patients with a previous Billroth II gastrectomy. Endoscopy 1996; 28: 254– 255.

26. Hintze RE, Veltzke W, Adler A et al. Endoscopic sphincterotomy using an S- shaped sphincterotome in patients with a Billroth II or Roux- en- Y gastrojejunostomy. Endoscopy 1997; 29: 74– 78.

27. Costamagna G, Mutignani M, Gabbrielli A et al. Endoscopic sphincterotomy in patients with Billroth II gastrectomy: improvements with a new inverted sphincterotome (abstract). Gastroenterology 1993; 104: A357.

28. Cuningham JT. Endoscopic papillotomy and stent insertion: B II technique and limitations. In: Barkin J, Opelhan C (eds). Advanced therapeutic endoscopy. New York: Raven Press 1990: 193– 200.

29. Korbička J, Čapov I, Vlček P. Pneumoperitoneum bez perforace trávicího ústrojí. Rozhledy v chirurgii 2002; 81: 364– 371.

30. Zavoral M. Komplikace endoskopické papilotomie. Endoskopie 1995; 4: 25– 28.

31. Novotný I. Krvácení z Vaterovej papily. Gastroenterológia pre prax 2005; 4: 13– 16.

32. Frič P, Ryska M. Digestivní endoskopie a laparoskopická chirurgie. Praha: Praha Publishing 1996.