Endoscopic sphincterotomy in billroth II patients
Endoscopic sphincterotomy (ES) is particulary difficult in patients with previous Billroth II gastrectomy, when a reverse approach to enter and cut the papilla must be used. A further method using a diathermic needle type cutter has been proposed by us in Billroth II patients in 1984. Now we have developed a modified technique, positioning a naso biliary tube in the common bile duct before starting ES. So the sphincterotomy can be performed by a diathermic needle using the catheter as a guide. In this way the risk of perforation of the posterior duodenal wall and of pancreatitis are avoided because the cutting direction and the depth of the section are well controlled maintaining the diathermic needle upward respect to the position of the catheter. Over the last 10 years 2082 ERCP and 1557 ES have been carried out in our Endoscopic Unit. Of these 98 ES have been performed in Billroth II patients. Technical implications and results are described.
G. BEDOGNI, E. RICCI, M.G. MORTILLA, G. BERTONI, R. CONIGLIARO, G.P. KONIDIS