Korean Journal of Gastrointestinal Endoscopy 1992;12(2): 271-277.
Billroth-Ⅱ 위절제술 환자에서 치료 내시경적 역행성 담관췌관조영술 ( Therapeutic Endoscopic Retrograde Cholangiography in Patients with a Billroth Ⅱ Gastrectomy - 2 cases of ERBD & 1 case of endoscopic stone retrievial - )
이동기, 이성우, 김승률, 배선우, 장우익, 권상옥 (Dong Ki Lee, Sung Woo Lee, Sung Rul Kim, Sun Woo Bae, Woo Ick Jang and Sang Ok Kwon)
Abstract
Endoscopic retrograde cholangiopancreatography(ERCP) procedures are more difficult in patients who have undergone partial gastrectomy with Billroth II anastomosis. Because its altered anatomical relationship. the endoscopist is presented with additional problems: (i) Dfficulties in entering the afferent loop, depending on the surgical techiques used. (ii) The endoscope may be too sort to reach the papillary region unless the loops are suecessfully straightened out. (iii) Difficulties in passing the ligament of Treitz, especially in patients with Braun's anastomosis, (iv) Problems in cannulating the papilla and especially the common bile duct from a reversed position. (v) Problems in carrying out a papillotomy in a correct position. We attempted endoscopic sphincterotomy in 3 opatients previously subjected to gastrectomy with needle knife, and succeeded in 2 of them. In the two patients, successful billary drainage was achieved. And one patients with Billroth II gastrectomy, presented with CBD stone and cholangit, was successfully treated with endoscopic stone retriveial. The patient with a Billroth-II operation may unergo endscopic diagnostic as well as thera peutic procedures with a high rate of success, and can be suitable candidates for ERCP and endoscopic sphincterotomy
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