Endoscopic retrograde cholangiopancreatography in patients undergoing gastric resection according to Billrot-II

Introduction. The relevance of using endoscopic retrograde cholangiopancreatography in patients after gastric resection according to Billroth II remains high, since up to 15–20 % of them face pathology of the biliary tract in the long term. According to research data, the actual success rate of ERCP in these conditions ranges from 61,7 % to 88,2 %, which is lower than in patients with unchanged anatomy (more than 95 %), due to the complexity of selective cannulation through a long adductor loop. Thus, the improvement of ERCP methods for the operated stomach remains critically important. The purpose of the study. To evaluate the effectiveness of endoscopic retrograde cholangiopancreatography in patients undergoing gastric resection according to Billroth II using a clinical case example. Materials and methods. A literature review was conducted using the electronic databases PubMed, Google Scholar, Scopus, and elibrary. The features of endoscopic retrograde cholangiopancreatography in patients who underwent gastric resection according to Billroth II are described using the example of a clinical case. Results. High-quality equipment and tools, teamwork of an experienced team of endoscopists, anesthesiologists, and surgeons are necessary for the successful completion of endoscopic interventions in the pancreato-biliary zone in patients after gastric resection according to Billrot II. As presented in the clinical case, the use of multi-stage minimally invasive interventions with various technical approaches and the individual choice of anesthetic aids can improve the outcome of treatment, which is critically important for patients with high operational risk. Conclusion. Thus, when choosing surgical tactics for performing ERCP in patients after gastric resection according to Billroth II, a personalized approach is needed to take into account not only previous operations and concomitant diseases, but also the anatomical features and compliance of the patient, which can greatly facilitate the implementation of the intervention.