Abstract
Background and Study Aims: Guide wire-assisted papillotomy is a well-established technique in conventional biliary
endoscopy, but has not been previously employed in Billroth II patients, due to the
lack of an appropriate papillotome that can accommodate a guide wire. We therefore
designed a Billroth II papillotome that can be inserted over a guide wire.
Patients and Methods: Over a 12-month period, 24 patients (18 males, six females, median age 72 years),
who had previously undergone a Billroth II gastrectomy and who were referred to our
department for therapeutic biliary endoscopic procedures, were included in this study.
Results: The papilla could be reached in 22 patients, but the procedure failed in two due
to an excessively long afferent loop. Cannulation of the bile duct with the standard
Billroth II papillotome was possible in 11 patients; the remaining 11 patients, in
whom free cannulation failed, underwent cannulation over the guide wire. Diagnostic
endoscopic retrograde cholangiography revealed bile duct stones in 17 patients, and
malignant-appearing common bile duct stenoses in five patients. Papillotomy was successfully
performed using the guide wire Billroth II papillotome in all patients, without complications.
Conclusion: The Billroth II papillotome is effective and safe in patients in whom free cannulation
has failed using the standard Billroth II papillotome.
