| Objective To assess the feasibility and safety of endoscopic retrograde cholangiopancreatography in patients with surgically altered anatomy for pancreaticobiliary disease.According to the different anatomical structure,the patients are divided into three groups,Billroth Ⅱ reconstruction,partial or total gastrectomy Roux-en-Y anastomosis and choledochojejunostomy Roux-en-Y anastomosis.To compare success rate of operation and operation time of different anatomic structures.Methods We retrospectively analyzed 97 patients after surgery to change the normal digestive tract anatomy underwent endoscopic retrograde cholangiopancreatography in January 2013 to January 2016 in our hospital.All patients according to the different anatomical structures were divided into Billroth Ⅱ reconstruction,partial or total gastrectomy Roux-en-Y anastomosis,choledochojejunostomy Roux-en-Y anastomosis,three groups.We used gastroscopy,duodenoscopy,standard colonoscopy,lengthened colonoscopy and double balloon colonoscopy,then observe and compare different anatomical success rate of ERCP,success rate of insertion,insertion time,success rate of cannulation,cannulation time and complications.Theχ2 test and the Fisher exact test were used to compare success rate.And the Student t test was used to compare operation time.Comparisons were carried out using the one-way ANOVA.P<0.05 was considered to be statistically significant.Statistical analysis was performed using statistical software(SPSS version 17.0,SPSS,Chicago,IL).Results A total of 97 patients with the reconstruction of the digestive tract were involved in the study,with 74 patients successfully completing ERCP treatment,success rate of 76.3%(74/97).Study included 52 cases with Billroth Ⅱreconstruction(group A)and 20 patients with gastrectomy Roux-en-Y anastomosis(group B),25 patients with choledochojejunostomy Roux-en-Y anastomosis(group C).The endoscope insertion success rates of groups A,B,C were 96.2%(50/52),85.0%(17/20)and 80%(20/25),respectively.The χ 2 test showed that there was no significant difference between the 3 groups(P=0.068).The mean insertion time was 36.7,68.4 and 84.0 minutes,respectively.One-way ANOVA showed that the insertion time of group C was significantly longer than that of groups A and B(both P<0.001).The endoscopic cannulation success rates of groups A,B,C were 90%,82.4%and 100%,respectively.Theχ 2test showed that there was no significant difference between the 3 groups(P=0.144).The mean cannulation time was 19.4,28.1 and 20.4 minutes,respectively.One-way ANOVA showed that the cannulation time of group B was longer than that of groups A and C(P<0.001,P=0.001,respectively).There were 10 cases of adverse events,accounting for 10.3%(10/97)of the total cases.The adverse events included 3 pancreatitis(mild to moderate),4 hyperamylasemia,1 cholangitis,1 bleeding,and 1 cardiopulmonary accident.Bleeding happened after the PTC-guided rendezvous technique.The patient with cardiopulmonary accident presented with hypoxia and blood pressure drop during the ERCP procedure.All the patients were managed with conventional therapy. |
