Which scope is appropriate for endoscopic retrograde cholangiopancreatography after Billroth II reconstruction: An esophagogastroduodenoscope or a colonoscope?

Table 1 Comparison of patient characteristics between the esophagogastroduodenoscopy and colonoscopy groups

	EGDS group (n = 17)	CS group (n = 27)	P value
Age (yr, mean ± SD)	75.2 ± 13.0	75.7 ± 13.0	0.88
Sex, male/female	15/2	22/5	0.69
Period after B-II reconstruction (yr, mean ± SD)	36.8 ± 13.8	36.8 ± 13.8	1.0
Diseases treated with B-II reconstruction
Gastric ulcer, n	10	11
Duodenal ulcer, n	3	9
Gastric cancer, n	2	4
Pyloric stenosis, n	1	1
Gastric ptosis, n	1	1
Unknown, n		1
Untreated papilla of Vater, n (%)	15 (88.2)	27 (100)	0.14
Antithrombotic drugs, n (%)	2 (11.8)	5 (18.5)	0.69
Periampullary diverticulum, n (%)	1 (5.9)	3 (11.1)	1.0
Disease, n
Bile duct stone	11	20	0.52
Others	6	7
Biliary ductal cancer	3	2
Pancreatic cancer	1	3
Chronic pancreatitis	1	1
Benign biliary stricture	1	1
Transverse diameter of the largest stone (mm, mean ± SD)	10.2 ± 4.8	12.2 ± 3.8	0.24
Number of stones [n, median (range)]	4 (1 - 30)	2 (1 - 6)	0.18

EGDS: Esophagogastroduodenoscopy; CS: Colonoscopy; B-II: Billroth II.

Table 2 Comparison of endoscopic retrograde cholangiopancreatography procedural characteristics between the esophagogastroduodenoscopy and colonoscopy groups

	EGDS group (n = 17)	CS group (n = 27)	P value
EST, n (%)	7 (41.2)	19 (70.4)	0.07
EPBD or EPLBD, n (%)	6 (35.3)	13 (48.1)	0.54
Procedural time [min, median (range)]	60 (20-100)	90 (40-128)	< 0.01
Papilla of Vater access, n (%)	14 (82.4)	25 (92.6)	0.36
Stone clearance, n (%)	6/11 (54.5)	8/19 (42.1)	1.0
Stone destruction, n (%)	3/11 (27.3)	6/19 (31.6)	1.0
Procedural success, n (%)	14 (82.4)	17 (63.0)	0.20
Adverse events, n (%)	0 (0)	0 (0)
PEP, n (%)	0 (0)	0 (0)

EST: Endoscopic sphincterotomy; EPBD: Endoscopic papillary balloon dilation; EPLBD: Endoscopic papillary large balloon dilation; PEP: Post endoscopic retrograde cholangiopancreatography pancreatitis; CS: Colonoscopy.

Table 3 Factors influencing the endoscopic retrograde cholangiopancreatography procedural time

		Univariate analysis			Multivariate analysis
	Procedural time ≥ 70 min, n (yes/no)	OR	95%CI	P value	OR	95%CI	P value
Age ≥ 76 yr	13/9	2.09	0.63–6.94	0.23
Sex, male	17/20	0.34	0.06–1.98	0.23
Period after B-II reconstruction ≥ 40	11/11	1.0	0.31–3.26	1.0
Untreated papilla of Vater	21/21	1.0	0.06–17.1	1.0
Antithrombotic drug use	3/4	0.71	0.14–3.63	0.68
Periampullary diverticulum	1/3	0.30	0.03–3.15	0.32
Bile duct stone	15/16	0.8	0.22–2.94	0.74
Transverse diameter of largest stone ≥ 12.2 mm	7/8	0.77	0.18–3.21	0.72
Number of stones ≥ 2	10/7	2.29	0.52–10.0	0.27
CS group	17/10	4.08	1.11–5.0	0.035	3.97	1.05–15.0	0.04
EST	14/12	1.46	0.44–4.88	0.54
EPBD or EPLBD	10/9	1.20	0.37–3.97	0.76
Papilla of Vater access	20/19	1.58	0.24–10.5	0.64
Stone clearance	8/8	1.0	0.24–4.2	1.0
Stone destruction	6/3	2.67	0.52–13.7	0.24
Procedural success	15/19	0.34	0.07–1.54	0.16	0.36	0.07–1.74	0.2

EST: Endoscopic sphincterotomy; EPBD: Endoscopic papillary balloon dilation; EPLBD: Endoscopic papillary large balloon dilation; CS: Colonoscopy; B-II: Billroth II.

Table 4 The upper bending angle of esophagogastroduodenoscopy was greater than that of colonoscopy

	EGDS group	CS group	P value
	GIF-Q240X	PCF-Q260AI/AL
	GIF-Q260	PCF-PQ260L
	GIF-Q260J	SIF-Q260
Upper bending angle (degree)	210	180
Duodenal direction and catheter direction (cross/ parallel)1	11/3	8/15	0.02
Observation of papilla of Vater in the front, n (%)2	11 (78.6)	1 (3.8)	< 0.01

The duodenal and catheter directions crossed more frequently in the esophagogastroduodenoscopy group than in the Colonoscopy group. The observation of the papilla of Vater papilla could easily be achieved by esophagogastroduodenoscopy.

¹The cases with unsuccessful biliary cannulation were excluded.

²The cases with unsuccessful papilla of Vater identification were excluded. EGDS: Esophagogastroduodenoscopy; CS: Colonoscopy.