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Endoscopy 2006; 38(12): 1241-1245
DOI: 10.1055/s-2006-945003
Original article
© Georg Thieme Verlag KG Stuttgart · New York

Endoscopic retrograde cholangiopancreatography in post-Whipple patients

P.  Chahal1 , T.  H.  Baron1 , M.  D.  Topazian1 , B.  T.  Petersen1 , M.  J.  Levy1 , C.  J.  Gostout1
  • 1Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, Maryland, USA
Further Information

Publication History

Submitted 3 March 2006

Accepted after revision 8 August 2006

Publication Date:
11 December 2006 (online)

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Background and study aims: Endoscopic retrograde cholangiopancreatography (ERCP) is an established modality for evaluation and treatment of pancreaticobiliary disorders. However, it is technically more challenging in patients with post-surgical anatomy. The success rate of ERCP in patients with prior pancreaticoduodenectomy (Whipple resection) is unknown. We assessed the technical success and safety of ERCP in this patient population.
Patients and methods: Post pancreaticoduodenectomy patients who had undergone ERCP between January 2002 and May 2005 were identified through a computerized medical index system. ERCP was considered successful if the duct of clinical interest had been cannulated and endoscopic therapy had been performed when indicated.
Results: ERCP was attempted 88 times in 51 patients with prior pancreaticoduodenectomy, including 37 procedures for pancreatic indications, 44 for biliary obstruction, and 7 for both biliary and pancreatic indications. The overall technical success rate of ERCP based on the intention behind the procedure was 51 % (45 of the 88 procedures). Success was significantly more likely for biliary indications (37/44, 84 %) than for pancreatic indications (3/37, 8 %) (P ≤ .001). Complications occurred in 2 % of the procedures and included one self- contained perforation treated medically and one Mallory-Weiss tear.
Conclusions: When performed by experienced endoscopists, ERCP in patients with prior pancreaticoduodenectomy is safe, with a high success rate for biliary indications and a low success rate for pancreatic duct indications. Better methods of achieving pancreatic duct cannulation after pancreaticoduodenectomy are needed.

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T. H. Baron, M. D.

Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine

200 First St SW · Rochester · MN, 55901 · USA

Fax: +01-507-266-3939

Email: baron.todd@mayo.edu