Abstract
Background and Study Aims: A prospective, randomized study was carried out to compare the success and complication
rates associated with the forward-viewing endoscope and side-viewing duodenoscope
in conducting endoscopic retrograde cholangiopancreatography (ERCP) and needle-knife
sphincterotomy in patients with a Billroth II gastrectomy.
Patients and Methods: The study included 45 patients with a Billroth II gastrectomy who required ERCP and
endoscopic sphincterotomy (EST) for evaluation and management of pancreaticobiliary
disease. The patients were randomly assigned to receive ERCP and EST with either a
forward-viewing endoscope or a side-viewing duodenoscope.
Results: Cannulation of the papilla was successful in 68 % (15 of 22) in the side-viewing
duodenoscope group, and in 87 % (20 of 23) in the forward-viewing endoscope group.
Failures of cannulation occurred in seven patients in the side-viewing duodenoscope
group, caused by jejunal perforation during insertion (n = 4), by a long afferent
loop (n = 1), by a complaint of severe abdominal pain (n = l), and by failure to enter
the afferent loop (n = I). In the forward-viewing endoscope group, failure occurred
in three patients due to the long afferent loop (n = 2) and to an inability to cannulate
despite identification of the papilla (n = l). Sphincterotomy was successfully completed
in eight of ten patients (80 %) in the side-viewing duodenoscope group, and in ten
of twelve patients (83 %) in the forward-viewing endoscope group.
Conclusions: For ERCP and EST in patients with Billroth II gastrectomy, the forward-viewing endoscope
is as effective as the side-viewing duodenoscope, but it may be the safer of the two
instruments. The forward-viewing endoscope can be recommended for ERCP and EST in
patients with a Billroth II gastrectomy.
