ERCP after gastric resection – our experiences in 49 patients

Introduction: Gastric resection was a common operation before PPI era in pts with peptic ulcer. Performing ERCP in such a patient remained a challenging procedure, that presume some experience. Patients and methods: Between 2008 January and 2013 March we have performed 4888 ERCP interventions. We had 76 interventions (1.6%) in 49 pts (33 male, 16 female) with former gastric resection (8 pts with Billroth-I, 41 pts with Billroth-II). We used duodenoscope in 47 cases, duodenoscope and gastroscope in the same pts in 11 pts, and exclusively gastroscope in 18 pts. Results: In 8 pts with Billroth-I resection the indication of ERCP were bile duct stone in 4 pts, obstruction due to tumor in 3 pts and acute biliary pancreatitis in 1 patient. We performed 14 ERCP in 8 pts. All 5 pts with biliary stone was resolved, as 2 out of 3 with biliary obstruction due to tumor (7/8 success). In the remaining patient with unsuccesful ERCP the PTD was performed. In 41 pts with Billroth-II resection the indication of ERCP were: biliary stone disease in 20 pts, malignant stricture in 12 pts, papillary sclerosis in 3 pts, stenosis of biliodigestive anastomosis in 2 pts, and 1 – 1 case of acute biliary pancreatitis, post cholecystectomy bile leakage, juxtapapillary diverticula and pancreatic abscess. In 16/20 (80%) of pts with common bile duct stone sucessfully was resolved by ERCP (stone extraction and/or stent insertion), other 4 pts were sent to surgery. In 12 pts with malignant stricture we put stent in 8 pts (66%) (4 metal one), 3 cases were resolved by PTD, 1 patient was sent home due to his final stage of cancer. All pts with papillary stenosis, bile leakage, stenosed biliodigestive anastomosis and acute biliary pancreatitis were successfully managed endoscopically. In a patient with large juxtapapillary diverticula the obstruction resolved spontaneously, requiring no other intervention after unsuccessful ERCP. In a patient with pancreatic abscess the filling of the duct was successful, but that was not the case for putting a stent. This patient was referred to surgery. We had fever in 2 pts, 2 other needed transfusion, in one patient with severe pain after ERCP laparotomy was perfomed, but suspected perforation was not confirmed. Overall 3 pts died within 30 days after ERCP. Conclusion: In a high-volume center performing ERCP in pts after gastrectomy proved to be efficacious, successful and safe procedure.