Stent-Guided Sphincterotomy in Billroth II Gastrectomy Patients

Endoscopic sphincterotomy (EST) in post Billroth Ⅱ (B Ⅱ) gastrectomy patients is difficult due to the anatomical change and reversed direction of duodenal papilla. Various methods have been described with variable success and limitations. One of the problems is the difficulty in controlling the correct direction of EST. We used needle knife sphincterotome (NKS), performing EST over a biliary stent in 10 cases (stent-guided EST). The control of the direction of EST was satisfactory: Of ten cases, 8 were successful; the remaining 2 were unsuccessful due to the inability to cannulate deeply into the common bile duct (CBD). No complications occurred. The advantages of stent-guided EST are 1: correct direction of EST, and 2: protection of pancreatic duct by the stent. This can be a useful alternative method for EST in B Ⅱ gastrectomy patients.