Complications associated with ERCP in patients with a gastroenteric anastomosis

Patients with Billroth II, Whipple, or Roux-en-y type operations may be at increased risk for complications associated with ERCP. We retrospectively reviewed our experience with both the diagnostic and therapeutic portion of these procedures and tried to identify risk factors. Methods: All ERCPs performed in the past 10 years were reviewed, complications classified by standard criteria and charts were reviewed on each complication. Results: 74 procedures were performed with side viewing instruments on 52 patients. TYPE ANAST SEX:#(#proc) x̄ AGE (range) duct accessed BILLROTH M:31 (41) 65 yr (37-82) 32/41 // F:9 (17) 58yr (46-80) 15/17 ROUX-EN-Y M:2 (2) 61 yr (56-66) 0/2 F:5 (6) 39yr (21-56) 1/6 WHIPPLE F:5 (8) 60yr(35-78) 7/8 Complications occurred in 5 cases (6.7%), mild pancreatitis 1, delayed hemorrhage 1, and perforation 3 (4%) with 0% mortality. Mean age of patients suffering perforation was 80 (78-82), all in the afferent limb, all recognized immediately and occurred prior to reaching papilla/duct. 2 perforations occurred at an area of angulation and fixation of bowel and were associated with simultaneous angulation and torque of the side viewing endoscope to improve visualization. Open surgical exploration and closure was accomplished in all perforations; an ERCP nasobiliary catheter left through one perforation facilitated localization at surgery. CONCLUSIONS: ERCP in patients with gastroenteric anastomoses is associated with an increased risk of perforation of the afferent limb during the diagnostic phase of the study, particularly the elderly. When reaching areas of sharp angulation/fixation reendoscopy with an end viewing instrument and leaving a guidewire/catheter to mark the course of the bowel may diminish the incidence of this complication.