Vol.:(0123456789) 1 3 Surgical Endoscopy https://doi.org/10.1007/s00464-020-07904-x A comparative study of side‑viewing duodenoscope and forward‑viewing gastroscope to perform endoscopic retrograde cholangiopancreatography in patients with Billroth II gastrectomy Orhan Coşkun 1  · Bülent Ödemiş 1 Received: 26 April 2020 / Accepted: 17 August 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020 Abstract Background/aim Endoscopic retrograde cholangiopancreatography (ERCP) in patients with Billroth II gastrectomy is a difcult procedure. Although diferent endoscopes are used in these patients, comparative studies are limited. The aim of this study was to assess the efcacy and the safety of the forward-viewing gastroscope compared with the side-viewing duodenoscope. Materials and methods This study was conducted on 75 Billroth II gastrectomy patients who underwent ERCP by the same experienced endoscopist. Procedures were performed using side-viewing duodenoscope in the frst 41 patients and forward- viewing gastroscope in the subsequent 34 patients. The success and complication rates of ERCP were compared between the two groups. Results Aferent loop intubation was achieved in 39 patients (95.1%) in the side-viewing duodenoscope group and in 34 patients (100%) in the forward-viewing gastroscope group (P = 0.49). The rates of reaching the papilla was 70.7% (n = 29) and 91.1% (n = 31), respectively (P = 0.06). Cannulation success rate after reaching the papilla was 100% in the side-viewing duodenoscope group and 90.3% in the forward-viewing gastroscope group. In the side-viewing duodenoscope group, 11 patients underwent sphincterotomy (EST), 14 patients underwent both EST and endoscopic papillary balloon dilatation (EPBD), and 4 patients underwent only EPBD. All but one patients in the forward-viewing gastroscope group underwent EPBD without EST. The technical and the clinical success rate did not statistically difer between the groups (70.7% vs. 82.3%, 68.3% vs. 79.4%, respectively). Adverse events included jejunal perforation in one patient (2.4%) in the side-viewing duodenoscope group, and pancreatitis in one patient (2.9%) in the forward-viewing gastroscope group (P > 0.05). Conclusion This study indicates that forward-viewing gastroscope is as efective as side-viewing duodenoscope for ERCP in patients with Billroth II gastrectomy. Furthermore, EPBD without prior EST appears to be a safe and efective procedure in these patients. Keywords Endoscopic retrograde cholangiopancreatography · Billroth II operation · Endoscope · Duodenoscope Endoscopic retrograde cholangiopancreatography (ERCP) is considered the frst step treatment of many biliary and pancreatic diseases [1]. Experienced endoscopists can suc- cessfully perform many ERCP procedures in patients with normal anatomy. However, in patients with Billroth II gas- trectomy, ERCP is a difcult procedure because of surgi- cally altered anatomy. Entering the aferent loop, advancing towards the papilla, visualizing the papilla, cannulating the desired duct, and performing endoscopic sphincterotomy (EST) are the main problems [1, 2]. While the risk of per- foration during ERCP is 0.1- 0.6% in patients with normal anatomy, this rate can rise to 10% in patients with Billroth II gastrectomy [1, 3, 4]. The incidence of other ERCP-related complications in patients with Billroth II gastrectomy is similar to that of patients with normal anatomy [5]. Although different endoscopes such as side-viewing duodenoscope, anterior oblique vision endoscope, forward- viewing gastroscope and balloon enteroscope are used in Billroth II gastrectomy patients, comparative studies are lim- ited. The advantage of using a side-viewing duodenoscope is and Other Interventional Techniques * Bülent Ödemiş odemisbulentmd@yahoo.com 1 Department of Gastroenterology, Türkiye Yüksek İhtisas Education and Research Hospital, Ankara, Turkey