The utility of a multibending endoscope for selective cannulation during ERCP in patients with a Billroth II gastrectomy (with video)

BackgroundSelective cannulation in patients with a Billroth II gastrectomy is still challenging.ObjectiveTo evaluate the usefulness of a multibending, forward-viewing endoscope (M-scope) for selective cannulation during diagnostic or therapeutic ERCP in patients with a Billroth II gastrectomy.DesignCase series.SettingTertiary center.PatientsFourteen patients having biliary disease with a Billroth II gastrectomy in whom selective cannulation failed when using a conventional forward-viewing endoscope.InterventionsIn all cases, we attempted selective biliary cannulation for ERCP with a single-bending, forward-viewing endoscope for 10 minutes. After failure with the conventional endoscope, we retried selective cannulation with the M-scope for 10 minutes. After cannulation, the diagnostic or therapeutic endoscopic procedures were performed.Main Outcome MeasurementsWe assessed the success rate of selective cannulation, the possibility of therapeutic approaches, and procedure-related complications.ResultsIn all cases, we successfully reached the ampulla of Vater with the M-scope. The overall success rate of selective cannulation with the M-scope was 92.9% (13/14). One patient developed mild pancreatitis. Therapeutic procedures such as sphincterotomy, balloon dilatation, stone removal, and biliary drainage were all possible.LimitationsSmall number of patients; uncontrolled, single-center study.ConclusionsThe M-scope seems to be helpful for selective cannulation during ERCP in patients with a Billroth II gastrectomy. All diagnostic and therapeutic procedures were possible through the M-scope.