Endoscopy Master Videos: ERCP Billroth II video @ www.gastroliver.com.sg

This case ilustrates the challanges of ERCP in a case with peri-ampullary diverticulum plus Billroth II anatomy.
ERCP in Billroth II gastrectomy is extremely challenging in 2 respects: (1) Intubation of the afferent limb and negotiation of the duodenoscope to the papilla and (2) cannulation of the papilla. Maneuvering the duodenoscope to the papilla must be gentle and done under fluoroscopic guidance. Resistance to passage of the scope should be a warning to stop further insertion to avoid perforation. The scope approaches the papilla in a retrograde direction. The papilla is identified inside a large diverticulum. Cannulation of the bile duct is towards the 6 o'clock direction. After cannulation, contrast injection causes the intra-diverticulum portion of the bile duct to bulge. A guide wire is inserted followed by a temporary biliary stent. A needle knife is used to incise the papilla, using the biliary stent as a guide (not shown). The completed sphincterotomy is dilated with a biliary balloon. Note the pancreatic orifice is at the 11 o'clock position, the opposite orientation of the standard anatomy.

Category:

Science & Technology

Tags:

• ERCP
• Billroth
• II
• diverticulum
• Singapore
• gastroenterologist
• dave
• project
• international
• gastroenterology