Korean Journal of Gastrointestinal Endoscopy 2010;41(6): 344-349.
초심자에서 투명캡 장착 직시경을 이용한 ERCP
박은서ㆍ이태훈ㆍ박상흠ㆍ고규봉ㆍ손범석ㆍ심윤숙ㆍ이세환ㆍ김홍수ㆍ김선주
순천향대학교 의과대학 천안병원 소화기내과학교실
Cap-assisted ERCP in Surgically Altered Anatomy
Eun Seo Park, M.D., Tae Hoon Lee, M.D., Sang-Heum Park, M.D., Gyu Bong Ko, M.D., Bum Suk Son, M.D., Yun Suk Shim, M.D., Sae Hwan Lee, M.D., Hong-Soo Kim, M.D. and Sun-Joo Kim, M.D.
Department of Internal Medicine, Cheonan Hospital, Soonchunhyang University College of Medicine, Cheonan, Korea
Abstract
Background/Aims: Endoscopic retrograde cholangiopancreatography (ERCP) is a difficult procedure to perform on patients who have undergone a Billroth II gastrectomy, Whipple's operation or Roux-en-Y gastrobypass surgery. Our study was designed to evaluate the clinical usefulness of cap-assisted ERCP for beginner endoscopists in cases of surgically altered anatomy.
Methods: From April 2008 to March 2010, 16 patients with biliary diseases and who had previously undergone abdominal surgery such as Billroth II gastrectomy or Roux-en-Y operation were analyzed. A single endoscopist performed all the procedures using a cap-assisted gastroscope, after ERCP training.
Results: Cap-assisted ERCP was attempted in 24 sessions of 16 patients. Afferent loop intubation and selective bile duct cannulation was successfully achieved in 19 sessions (79.1%). Among the patients who had undergone a Billroth II gastrectomy, 19 out of 20 sessions were successfully conducted. Only 4 patients who had undergone a previous Roux-en-Y operation failed afferent loop intubation. Duodenal free wall perforation developed in one case. There were no cases of mortality.
Conclusions: Therapeutic cap-assisted ERCP was useful in patients who had previously undergone a Billroth II gastrectomy and this may be helpful for inexperienced endoscopists. (Korean J Gastrointest Endosc 2010;41:344-349)
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