Current status of endoscopic retrograde cholangiopancreatography in patients with surgically altered anatomy in Japan: Questionnaire survey and important discussion points at Endoscopic Forum Japan 2013

Background and Aim Endoscopic retrograde cholangiopancreatography (ERCP) in patients with surgically altered anatomy is still challenging. We aimed to clarify the current status of ERCP in Japan in patients with surgically altered anatomy. Methods Questionnaire survey was conducted in 2012 at 11 participating facilities regarding ERCP in patients with surgically altered anatomy. Results A total of 490 ERCP procedures were carried out in 273 patients with surgically altered anatomy. The breakdown of surgical procedures was as follows: Roux-en-Y (R-Y) reconstruction (n = 154 [31.4%]), pancreaticoduodenectomy (PD) (n = 136 [27.8%]), hepaticojejunostomy (n = 103 [21.0%]), liver transplantation (n = 20 [4.1%]), Billroth II reconstruction (n = 69 [14.1%]), and interposition after total gastrectomy (n = 8 [1.6%]). The overall success rate of reaching the target site was 91.8% (450 of 490 ERCP procedures). According to reconstructive surgical procedures, the target site was reached in 138 of 154 procedures (89.6%) for R-Y reconstruction, 129 of 136 procedures (94.8%) for PD, 89 of 103 procedures (86.4%) for hepaticojejunostomy, 18 of 20 procedures (90.0%) for liver transplantation, 68 of 69 procedures (98.6%) for Billroth II reconstruction, and eight of eight procedures (100%) for interposition after total gastrectomy. Conclusions The success rate of reaching the target site was high in patients with Billroth II reconstruction and low in patients with hepaticojejunostomy. Although the success rate of endoscopic insertion for ERCP in patients with surgically altered anatomy was high, there are still cases in which it is difficult to achieve technical success.