Surgically Altered Anatomy and Special Considerations

Successful passage of the endoscope with cannulation of the ampulla is only achieved in 50% to 85% of patients with Billroth II anastomoses (in contrast to the 90% success rate that can be attained in patients with normal anatomy). This is due to both the difficulty in maneuvering through a variably long or angled afferent limb and the unusual position of the papilla once it is reached. Some endoscopists prefer to use a pediatric colonoscope or gastro-scope, others prefer to use the duodenoscope. Specialized papillotomes are often required for therapeutic maneuvers. The indications for performing ERCP in patients with a Billroth II anastomosis are identical to those in patients with normal anatomy.