Endoscopic Pancreatocholangiography after Billroth II Operation

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There has been recently a rapid and marked advance in Gastroduodenal fiberscopy and endoscopic pancreatocholangiography (EPCG). They have become popular and are now one of the routine valuable examinations.However, observation of the afferent loop and EPCG after Billroth II operation in the stomach is not yet satisfactory at present. The purpose of this study is to develop techniques of EPCG in patients with Billroth II gastroenterostomy. EPCG after Billroth II operation was attempted in 20 cases and of these 15 were successful.A lateral viewing duodenoscopy (JF type B) was applied to 5 cases and was successful in 3. The pancreatic duct was visualized in these 3 cases, and the biliary duct system was in one of them.A forward viewing gastrointestinal fiberscopy (GIF type D, D2, JF type D) was applied to 15 cases and was successful in 12. The pancreatic duct was visualized in 10 cases, the biliary duct system was in 7 cases, both pancreatic and biliary ducts were in 5 cases.It was technically difficult 1) to insert in the afferent loop through the anastomosis 2) to pass through the Treitz's ligament and 3) cannulation from the anal side. The technique of EPCG after Billroth II operation was discussed in this paper.Improvement of the instruments and skillful manipulation of the endoscopy will make it easier to visualize the full length of the afferent loop and to perform EPCG after Billroth II operation.
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