Background and study aims: Patients undergoing pancreaticoduodenectomy develop postoperative complications related to surgery and their disease. Very little data are available on the role or success of endoscopic retrograde cholangiopancreatography (ERCP) in such patients. The aim of this study was to evaluate the indications and role of diagnostic and therapeutic ERCP after pancreaticoduodenectomy for both benign and malignant disease.
Patients and methods: This study was a 10-year (1990 - 2000) single institution retrospective review of all ERCPs performed on patients who had undergone pancreaticoduodenectomy surgery. Indications for the ERCP and technical procedural success were studied.
Results: 29 patients with a pancreaticoduodenectomy underwent 56 ERCPs. Reasons for surgery were neoplasia and chronic pancreatitis. Indications for ERCP included evaluation of jaundice and pain. Technical success related to the clinical indication (jaundice 69 %, pain 54 %).
Conclusion: ERCP plays an important role in the management of postpancreatic surgery problems including biliary and anastomotic strictures, and should be the modality of choice. However, surgical technique may make the afferent limb inaccessible, and the ductal anastomosis difficult to identify in patients with some types of pancreaticoduodenectomy. Closer collaboration between surgeon and endoscopist may allow alterations in surgical technique to improve postoperative ERCP success.
References
-
1
Bolman R M 3rd.
Surgical management of chronic relapsing pancreatitis.
Ann Surg.
1981;
193
125-131
-
2
Traverso L W, Tompkins R K, Urrea P T, Longmire W P Jr.
Surgical treatment of chronic pancreatitis. Twenty-two years' experience.
Ann Surg.
1979;
190
312-319
-
3
Whipple A.
Treatment of carcinoma of the ampulla of Vater.
Ann Surg.
1935;
102
763-769
-
4
Feitoza A B, Baron T H.
Endoscopy and ERCP in the setting of previous upper GI tract surgery. Part II: postsurgical anatomy with alteration of the pancreaticobiliary tree.
Gastrointest Endosc.
2002;
55
75-79
-
5
Gervais D A, Fernandez-del Castillo C, O’Neill M J. et al .
Complications after pancreatoduodenectomy: imaging and imaging-guided interventional procedures.
Radiographics.
2001;
21
673-690
-
6
Kugelberg C, Wehlin L, Arnesjo B, Tylen U.
Endoscopic pancreatography in evaluating results of pancreatico-jejunostomy.
Gut.
1976;
17
267-272
J. Farrell M. D.
Division of Digestive Diseases · UCLA School of Medicine
Los Angeles, CA 90405 · USA·
Fax: +1-310-794-9718
eMail: jfarrell@mednet.ucla.edu
