Analysis Of Endoscopic Retrograde Cholangiopancreatography Using In Patients With Billroth ? Gastrectomy

Research background:The endoscopic retrograde cholangiopancreatography (ERCP)as an intuitive and minimally invasive treatment technology, become an important means of diagnosis of pancreas and biliary diseases.ERCP with duodenoscope is a routine technique in diagnosis and treatment Pancreaticobiliary disease. The success rate is 90% to 95% for patients with normal anatomy[1].But for patients with surgically altered gastrointestinal anatomy, It is difficult to diagnosis and treatment of ERCP. Because of the inability of the endoscope to reach the blind end due to the long bowel passage,and of the complicated angulation. Some acute angled surgical limbs preclude the scope maneuverability and hinder the scope advancement. Duodenal papilla opening direction is contrast to the conventional ERCP [2-5]. In recent years,with the development of new equipment and improvement of operational skills, such as increased the success rate of EPCP for patients with surgically altered gastrointestinal anatomy. In this essay,we anolosis the success rate of ERCP for patients with surgically altered gastrointestinal anatomy and disscuss selection of endoscope, provide theory for clinical operation.Objectives:1. Disscuss the difficulty of ERCP for patients with Billroth ? gastrectomy.2. Disscuss the feasibility and safety of ERCP with duodenoscope and gastroscope for patients with Billroth ? gastrectomy.3?Compare the advantages and disadvantages of ERCP with duodenoscope and gastroscope for patients with Billroth ? gastrectomy.4?Disscuss ERCP endoscopic selection for patients with for patients with Billroth II gastrectomy.Methods : The object of study was the clinical data of 44 patients with Billroth II gastrectomy and bile pancreatic duct disease in the second affiliated hospital of kunming medical university digestive department endoscopy room from 1 July 2007 to 31 December 2015. Including, 40 cases operate with duodenoscopy, 4 cases who operate with, change . Analysis the success rate and complication rates.Results: 44 patients, a total of 32 patients were removed successfully, the success rate of intubation was 72.7%. Among 28 cases operate with duodenoscopy, 4 cases change gastroscope because duodenoscopy hard to reach duodenal papilla. The 12 failure patients were duodenoscopy operation. Failure reason: The endoscopic length is not long enough to reach duodenal papilla for 10 cases,2 cases because of intubation is not successful. Complication: Acute pancreatitis in 2 cases (6.2%); High blood amylase in 2 cases (6.2%).44 cases operate with duodenoscopy , 28 cases successed, the success rate of 63.3%.Operating time is 11 ?89 min,the average operation time 28.78± 10.33 min,stone 0.5?1.7 cm in diameter,average stone 0.70±0.50 cm in diameter.4 cases operate with gastroscope , 4 cases successed, the success rate of 100%.Operating time 52 ?75 min,the average operation time 63.50 ± 13.28 min, stone 0.5?0.6 cm in diameter, average stone 0.60 ± 0.00 cm in diameter.Conclusions:1. ERCP is safe and effective technology in the diagnosis and treatment of choledocholithiasis for patients with Billroth ? gastrectomy.2. Duodenoscopy and gastroscope all can be used in patients with Billroth ?gastrectomy, both methods have their advantages and disadvantages.3. ERCP with duodenoscopy is still the first choice for patients with Billroth ? gastrectomy, gastroscope can be used to supplement to improve the success rate of ERCP in patients with Billroth ? gastrectomy.