A New Guide Wire Papillotome for Patients with Billroth II Gastrectomy

Abstract

Background and Study Aims: Guide wire-assisted papillotomy is a well-established technique in conventional biliary endoscopy, but has not been previously employed in Billroth II patients, due to the lack of an appropriate papillotome that can accommodate a guide wire. We therefore designed a Billroth II papillotome that can be inserted over a guide wire.

Patients and Methods: Over a 12-month period, 24 patients (18 males, six females, median age 72 years), who had previously undergone a Billroth II gastrectomy and who were referred to our department for therapeutic biliary endoscopic procedures, were included in this study.

Results: The papilla could be reached in 22 patients, but the procedure failed in two due to an excessively long afferent loop. Cannulation of the bile duct with the standard Billroth II papillotome was possible in 11 patients; the remaining 11 patients, in whom free cannulation failed, underwent cannulation over the guide wire. Diagnostic endoscopic retrograde cholangiography revealed bile duct stones in 17 patients, and malignant-appearing common bile duct stenoses in five patients. Papillotomy was successfully performed using the guide wire Billroth II papillotome in all patients, without complications.

Conclusion: The Billroth II papillotome is effective and safe in patients in whom free cannulation has failed using the standard Billroth II papillotome.