• side-viewing duodenoscope
• endoscopic retrograde cholangiopancreatography
• postgastrectomy
• retrieval balloon–assisted enterography
• optimal ercp enterography route

AIM: To describe an optimal route to the Braun anastomosis including the use of retrieval-balloon-assisted enterography.

METHODS: Patients who received a Billroth II gastroenterostomy (n = 109) and a Billroth II gastroenterostomy with Braun anastomosis (n = 20) between January 2009 and May 2013 were analyzed in this study. Endoscopic retrograde cholangiopancreatography (ERCP) was performed under fluoroscopic control using a total length of 120 cm oblique-viewing duodenoscope with a 3.7-mm diameter working channel. For this procedure, we used a triple-lumen retrieval balloon catheter in which a 0.035-inch guidewire could be inserted into the “open-channel” guidewire lumen while the balloon could be simultaneously injected and inflated through the other 2 lumens.

RESULTS: For the patients with Billroth II gastroenterostomy and Braun anastomosis, successful access to the papilla was gained in 17 patients (85%) and there was therapeutic success in 16 patients (80%). One patient had afferent loop perforation, but postoperative bleeding did not occur. For Billroth II gastroenterostomy, there was failure in accessing the papilla in 15 patients (13.8%). ERCP was unsuccessful because of tumor infiltration (6 patients), a long afferent loop (9 patients), and cannulation failure (4 patients). The papilla was successfully accessed in 94 patients (86.2%), and there was therapeutic success in 90 patients (82.6%). Afferent loop perforation did not occur in any of these patients. One patient had hemorrhage 2 h after ERCP, which was successfully managed with conservative treatment.

CONCLUSION: Retrieval-balloon-assisted enterography along an optimal route may improve the ERCP success rate after Billroth II gastroenterostomy and Braun anastomosis.

• Retrieval-balloon-assisted enterography
• Billroth II gastroenterostomy
• Braun anastomosis
• Optimal enterography route
• Gastrojejunal anastomosis
• Efferent loop
• Endoscopic retrograde cholangiopancreatography
• Duodenoscope
• Enterography success rate
• Therapeutic success rate

• Aged
• Aged, 80 and over
• Catheters
• Cholangiopancreatography, Endoscopic Retrograde/adverse effects
• Cholangiopancreatography, Endoscopic Retrograde/instrumentation
• Cholangitis/diagnosis
• Cholangitis/etiology
• Cholangitis/therapy
• Duodenoscopes
• Equipment Design
• Female
• Gallstones/diagnosis
• Gallstones/etiology
• Gallstones/therapy
• Gastroenterostomy/adverse effects
• Humans
• Jaundice, Obstructive/diagnosis
• Jaundice, Obstructive/etiology
• Jaundice, Obstructive/therapy
• Male
• Middle Aged
• Retrospective Studies
• Stomach Neoplasms/surgery
• Treatment Outcome

Endoscopic retrograde cholangiopancreatography (ERCP) is efficacious in patients who have undergone Billroth II gastroenterostomies, but the success rate decreases in patients who also have experienced Braun anastomoses. There are currently no reports describing the preferred enterography route for cannulation in these patients. We first review the patient’s previous surgery records, which most often indicate that the efferent loop is at the greater curvature of the stomach. We recommend extending the duodenoscope along the greater curvature of the stomach and then advancing it through the “lower entrance” at the site of the gastrojejunal anastomosis, along the efferent loop, and through the “middle entrance” at the site of the Braun anastomosis to reach the papilla of Vater. Ten patients who had each undergone Billroth II gastroenterostomy and Braun anastomosis between January 2009 and December 2011 were included in our study. The overall success rate of enterography was 90% for the patients who had undergone Billroth II gastroenterostomy and Braun anastomosis, and the therapeutic success rate was 80%. We believe that this enterography route for ERCP is optimal for a patient who has had Billroth II gastroenterostomy and Braun anastomosis and helps to increase the success rate of the procedure.

• Optimal enterography route
• Endoscopic retrograde cholangiopancreatography
• Billroth II
• Gastroenterostomy
• Braun anastomosis

• Aged
• Aged, 80 and over
• Cholangiopancreatography, Endoscopic Retrograde/instrumentation
• Cholangiopancreatography, Endoscopic Retrograde/methods
• Duodenoscopes
• Female
• Gastroenterostomy/methods
• Humans
• Male
• Middle Aged