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Pancreatic endosonography after Billroth II gastrectomy.

Lee JH, Topazian M

Section of Digestive Diseases, Dept. of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA.

BACKGROUND AND STUDY AIMS: Prior Billroth II gastrectomy is considered a relative contraindication to endoscopic ultrasonography (EUS) of the pancreatic head. This study reviews experience with pancreatic EUS in such patients. PATIENTS AND METHODS: Eleven patients were identified who had previous Billroth II gastrectomy and underwent attempted pancreatic EUS. RESULTS: Examination of the pancreatic head was technically feasible in 10 of the patients. The inferior pancreatic head, ampulla, and periampullary ducts were seen in all; the superior pancreatic head and porta hepatis were visualized in 50 % of cases with radial echo endoscopes and 100 % with a linear-array echo endoscope. The pancreatic neck was fully imaged in 25 % of cases with radial echo endoscopes and in 60 % with a linear-array echo endoscope. One known pancreatic neck mass was not visualized. CONCLUSIONS: Pancreatic EUS is technically feasible in most patients with a prior Billroth II gastrectomy. Linear-array echo endoscopes provide a more complete examination than radial echo endoscopes. The pancreatic neck may be difficult to visualize.

Published 2 November 2004 in Endoscopy, 36(11): 972-5.
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