Pancreatic endosonography after Billroth II gastrectomy

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.