To evaluate the feasibility and safety of duodenoscopy-guided ERCP in the diagnosis and treatment of biliary and pancreatic diseases after digestive tract reconstruction.

Clinical data of 45 patients with biliary and pancreatic diseases after digestive tract reconstruction who underwent ERCP in the First Affiliated Hospital of Xi'an Jiaotong University from January, 2014 to March, 2021 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 32 patients were male and 13 female, aged from 48 to73 years, with a median age of 65 years. History of digestive tract reconstruction surgeries included BillrothⅠ subtotal gastrectomy in 3 cases, Billroth Ⅱ subtotal gastrectomy in 32, pancreaticoduodenectomy (Whipple) in 6 and Roux-en-Y gastrojejunostomy in 4, respectively. Duodenoscopy-guided ERCP was performed for the diagnosis and treatment. The success rate and time of ERCP insertion, success rate and time of intubation and postoperative complications were analyzed.

The success rate of ERCP insertion was 3/3 in patients after Billroth Ⅰ subtotal gastrectomy, and the median time of ERCP insertion was 15(13-25) min. The success rate of intubation was 3/3, and the intubation time was 14(4-16) min. In patients after Billroth Ⅱ subtotal gastrectomy, the success rate of ERCP insertion was 91%(29/32), and the time of ERCP insertion was 35(26-48) min. The success rate of intubation was 93%(27/29), and the intubation time was 26(11-42) min.Among them, ERCP insertion was failed in 2 cases who subsequently underwent endoscopic ultrasound (EUS)-guided biliary tract puncture and drainage. The success rate of ERCP insertion was 6/6 in patients after Whipple, and the time of ERCP insertion was 106(46-177) min. The success rate of intubation was 3/6, and the intubation time was 28(15-52) min. The success rate of ERCP insertion in patients afterRoux-en-Y gastrojejunostomy was 2/4, and the time of ERCP insertion was 38(30-63) min. The success rate of intubation was 2/2, and the intubation time was 20(20-36) min. 2 patients with failure of ERCP insertion received EUS-guided hepatogastric anastomosis. For all patients, the overall success rate of ERCP insertion was 89%(40/45), and the time of ERCP insertion was 35(13-177) min. The overall success rate of intubation was 88%(35/40), and the intubation time was 27(4-52) min. Postoperatively, 3 cases developed fever,1 presented with gastrointestinal bleeding with unknown cause and 2 experienced hyperamylasemia. No severe complications were reported.

It is safe and feasible to perform duodenoscopy-guided ERCP for patients with biliary and pancreatic diseases after digestive tract reconstruction. EUS-guided biliary drainage can be employed as a remedial procedure for ERCP failure after digestive tract reconstruction.