A comparative study of side-viewing duodenoscope and forward-viewing gastroscope to perform endoscopic retrograde cholan
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and Other Interventional Techniques
A comparative study of side‑viewing duodenoscope and forward‑viewing gastroscope to perform endoscopic retrograde cholangiopancreatography in patients with Billroth II gastrectomy Orhan Coşkun1 · Bülent Ödemiş1 Received: 26 April 2020 / Accepted: 17 August 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Background/aim Endoscopic retrograde cholangiopancreatography (ERCP) in patients with Billroth II gastrectomy is a difficult procedure. Although different endoscopes are used in these patients, comparative studies are limited. The aim of this study was to assess the efficacy and the safety of the forward-viewing gastroscope compared with the side-viewing duodenoscope. Materials and methods This study was conducted on 75 Billroth II gastrectomy patients who underwent ERCP by the same experienced endoscopist. Procedures were performed using side-viewing duodenoscope in the first 41 patients and forwardviewing gastroscope in the subsequent 34 patients. The success and complication rates of ERCP were compared between the two groups. Results Afferent loop intubation was achieved in 39 patients (95.1%) in the side-viewing duodenoscope group and in 34 patients (100%) in the forward-viewing gastroscope group (P = 0.49). The rates of reaching the papilla was 70.7% (n = 29) and 91.1% (n = 31), respectively (P = 0.06). Cannulation success rate after reaching the papilla was 100% in the side-viewing duodenoscope group and 90.3% in the forward-viewing gastroscope group. In the side-viewing duodenoscope group, 11 patients underwent sphincterotomy (EST), 14 patients underwent both EST and endoscopic papillary balloon dilatation (EPBD), and 4 patients underwent only EPBD. All but one patients in the forward-viewing gastroscope group underwent EPBD without EST. The technical and the clinical success rate did not statistically differ between the groups (70.7% vs. 82.3%, 68.3% vs. 79.4%, respectively). Adverse events included jejunal perforation in one patient (2.4%) in the side-viewing duodenoscope group, and pancreatitis in one patient (2.9%) in the forward-viewing gastroscope group (P > 0.05). Conclusion This study indicates that forward-viewing gastroscope is as effective as side-viewing duodenoscope for ERCP in patients with Billroth II gastrectomy. Furthermore, EPBD without prior EST appears to be a safe and effective procedure in these patients. Keywords Endoscopic retrograde cholangiopancreatography · Billroth II operation · Endoscope · Duodenoscope Endoscopic retrograde cholangiopancreatography (ERCP) is considered the first step treatment of many biliary and pancreatic diseases [1]. Experienced endoscopists can successfully perform many ERCP procedures in patients with normal anatomy. However, in patients with Billroth II gastrectomy, ERCP is a difficult procedure because of surgically altered anatomy. Entering the afferent loop, advancing * Bülent Ödemiş [email protected] 1
Department of Gastroenterology, Türkiye Yüksek İhtisas Educati
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