Endoscopy 2009; 41(10): 902-906
DOI: 10.1055/s-0029-1215087
Case report

© Georg Thieme Verlag KG Stuttgart · New York

Techniques to facilitate ERCP with a conventional endoscope in patients with previous pancreatoduodenectomy

M.  Matsushita1 , H.  Takakuwa2 , K.  Uchida1 , A.  Nishio1 , K.  Okazaki1
  • 1Third Department of Internal Medicine, Kansai Medical University, Osaka, Japan
  • 2Department of Gastroenterology, Tenri Hospital, Nara, Japan
Further Information

Publication History

submitted 19 January 2009

accepted after revision 9 July 2009

Publication Date:
11 September 2009 (online)

There is little guidance on the performance of endoscopic retrograde cholangiopancreatography (ERCP) in patients with previous pancreatoduodenectomy. We reviewed techniques for ERCP with a conventional endoscope and assessed its value in 10 patients with previous pancreatoduodenectomy (15 ERCPs). After exploration of the surgical reconstruction, we used a front-viewing endoscope, and we used a small firm pillow under the abdomen and hand compression for preventing loop formation. Successful insertion to the ductal anastomoses and biliary cannulation were achieved in 13 / 15 procedures (87 %). In 6 procedures where we attempted pancreatic cannulation, we could not identify the pancreatojejunostomy, but after spraying contrast around the suspected location of the ductal anastomosis we obtained a pancreatogram in 4 / 6 procedures (67 %). Endoscopic biliary interventions were successful in 6 / 7 procedures (86 %). No complications were encountered. Use of appropriate techniques makes ERCP with a conventional endoscope feasible, effective, and safe in patients with previous pancreatoduodenectomy. Endoscopic therapy can be performed successfully in the bile duct, but has limited value regarding the pancreatic duct.

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M. MatsushitaMD 

Third Department of Internal Medicine
Kansai Medical University

2-3-1 Shinmachi
Hirakata, Osaka 573-1191
Japan

Fax: +81-72-804-2061

Email: matsumit@hirakata.kmu.ac.jp