To evaluate the safety and efficacy of ERCP after digestive tract reconstruction.

Clinical data of 154 patients who underwent ERCP in Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine from January 1, 2020 to December 31, 2021 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 94 patients were male and 60 female, aged from 6 to 91 years, witha median age of 58 years. The digestive tract reconstruction techniques included Whipple-Child reconstruction in 48 cases, Roux-en-Y reconstruction in 60, and BillrothⅡsubtotal gastrectomy in 46, respectively. ERCP was performed using lateral-viewing duodenoscope and single-balloon enteroscopy by experienced surgeons. The operation time, success rate, treatment success rate and postoperative complications of ERCP were observed. The operation time of ERCP among 3 groups was compared by rank-sum test. The rate comparison was conducted by Chi-square test.

154 patients underwent 220 times of ERCP cumulatively, and 183 times of intubation of bile duct and pancreatic duct were successfully completed. The success rate of ERCP was 83.2%(183/220), and the clinical treatment success rate was 80.5%(177/220). The success rates of ERCP intubation after Whipple-Child reconstruction, Roux-en-Y reconstruction and BillrothⅡsubtotal gastrectomy were 86%(66/77), 86%(73/85) and 76%(44/58), respectively, and the clinical treatment success rates were 83%(64/77), 82%(70/85) and 74%(43/58), where no significant differences were observed among3 groups (χ²=2.276, 2.014; P>0.05). The median operation time of ERCP in 3 groups was 100(60), 130(93) and 74(60) min, respectively, and significant differences were observed (H=30.463, P<0.05). Postoperative mild pancreatitis occurred in 6 patients, who were discharged after symptomatic treatments, such as fasting and fluid replacement, etc. The incidence of postoperative complications was 1%(1/77) in the Whipple-Child reconstruction group, 1%(1/85) in Roux-en-Y reconstruction group and 12%(7/58) in BillrothⅡ subtotal gastrectomy group.

It is safe and efficacious to perform ERCP after digestive tract reconstruction. It is necessary to strictly review the surgical indications, make full preparations before ERCP, and should be carried out by experienced surgeons under teamwork.