Gastrectomies according to Billroth are made with a steadily declining frequency. On account of markedly changed postoperative conditions this type of resections has become a specific technical problem in endoscopic retrograde cholangiopancreatography (ERSP). Objective: The objective of the present retrospective study is an analysis of the success of diagnostic ERCP and subsequent therapeutic endoscopic operations of the pancreatobiliary system in our group of patients. Methods: From March 1994 till February 2000, i.e. in the course of 6 years 4692 ERCP were made. This number comprised 56 patients after gastrectomy according to Billroth II, where we achieved in 85.7% successful cannulation (i.e. in 48 patients). Indication for ERCP was in 21 instances choledocholithiasis, 6× acute pancreatitis, 9× jaundice, 7× a tumour of the pancreas, 1× chronic pancreatitis, 3× cholangoitis, 8× abdominal pain, and 1× a suspected leak after cholecystectomy. Results: The great majority of ERCP was therapeutic. In 43 cases we performed endoscopic papillotomy by some special papillotome. In a total of 5 patients we inserted into the biliary pathways a plastic duodenobiliary endoprosthesis (2× on account of a malignant stenosis of the choledochus associated with a pancreatic tumour, 2× as a palliative solution of extensive choledocholithiasis and 1× on account of a biliary leak after cholecystectomy).In a total of 31 patients ERCP revealed choledocholithiasis which was resolved completely in 25 patients (i.e. successful endoscopic treatment of choledocholithiasis in 80.6%). Conclusions: ERCP after Billroth II gastrectomy is much more pretentious as compared with standard operations. The success of diagnostic and in particular therapeutic ERCP is conditioned by adequate, variable equipment, the possibility to use several types of endoscopes and, of course, skill and great personal experien- ce of the endoscopist. It may be concluded that ERCP and therapeutic endoscopy in patients after Billroth II gastrectomy is nowadays, when the above conditions are respected, a safe and effective method in the diagnosis and treatment of pancreatobiliary disease and it is possible to achieve almost equal success as under normal anatomical conditions.

        Key words: endoscopic retrograde cholangiopancreatography – Billroth II gastrectomy – endoscopic papilloto- my – endoscopic therapy