Postoperative ERCP in the digestive tract involves two basic aspects: reconstruction of the digestive tract and the actual ERCP procedure. For postoperative ERCP in surgery, it is necessary to carefully review the patient's surgical history, especially the surgical records, and sketch the digestive tract reconstruction plan before the operation, drawing a diagram of the digestive tract reconstruction to determine the path of insertion. This method is more simple and efficient than attempting to navigate through the reconstructed digestive tract during the endoscopy.
If the ERCP operator is a gastroenterologist or endoscopist, it is necessary to collaborate with a surgeon, which includes sketching a diagram of the digestive tract reconstruction before the operation and guiding the endoscopic route during the procedure. This combination of serosal surgery and mucosal endoscopy is particularly important in the early stages of postoperative ERCP in the digestive tract. Surgeons are familiar with the methods, locations, anatomical structures, and insertion routes of digestive tract reconstruction, while endoscopists are skilled in endoscopy and insertion techniques. Through the cooperation of both surgical and endoscopic experts, the success rate of treating postoperative biliary and intestinal diseases can be significantly improved, which is one of the invaluable experiences in our center.
The difficulty of using the conventional duodenoscope for postoperative ERCP in the digestive tract lies in the failure of catheter insertion, which is mainly due to the anastomotic stoma being too long and twisted after the operation. Intestinal perforation is also a common and serious complication. Therefore, postoperative ERCP in surgery relies more on X-ray imaging. X-ray imaging can roughly determine the anastomotic stoma position, direction and insertion route, and the shape of the endoscope body. This information is critical in improving the success rate of catheter insertion and reducing complications such as intestinal perforation.
There is currently no consensus on how to categorize and standardize postoperative ERCP in the digestive tract. Based on the classification method for postoperative ERCP in the digestive tract, we describe the different strategies for treating various types of postoperative ERCP in our center. Post-gastrectomy ERCP requires biliary catheterization and usually requires cholecystolithotomy or stent placement. We use a duodenoscopy for this operation, using a balloon-guided catheterization method to improve the success rate of endoscope insertion. After successful insertion, duodenoscopy has advantages over other types of endoscopes for biliary catheterization and subsequent treatment.
Therefore, when conducting post-gastrectomy ERCP in surgery, it is more important to focus on improving the success rate of catheter insertion using conventional duodenoscopes, including trying and promoting the use of balloon-guided catheterization. The use of direct vision endoscopes, such as gastroscope, usually has a high success rate, but the insertion of a biliary catheter with a direct vision endoscope still has a considerable degree of difficulty. Therefore, if using direct vision endoscopy, efforts should be made to improve the success rate of biliary catheterization and treatment.