ERCP in Post-Billroth II Anatomy: Successful Management of Acute Cholangitis with Balloon Sphincteroplasty

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Text Biliary drainage in patients with surgically altered anatomy (SAA) is increasingly common due to the growing demand for bariatric surgery and other gastric procedures. ERCP in patients with Billroth II anatomy poses significant challenges, such as accessing the afferent loop, visualizing the papilla, and performing reverse-position sphincterotomy. The perforation risk increases from 0.1%-0.6% in normal anatomy to 10.2% in Billroth II patients. A 2015 study by Costamagna et al. recommended an inverted sphincterotome for sphincterotomy in such cases. This video case demonstrates the management of a patient with Billroth II anatomy and acute cholangitis. Despite the absence of an inverted sphincterotome, balloon sphincteroplasty up to 15 mm was successfully performed, followed by stone extraction. The patient showed rapid improvement and was discharged [ 1 ] [ 2 ] [ 3 ] [ 4 ] [ 5 ] [ 6 ] [ 7 ] [ 8 ]. Video http://data.process.y-congress.com/ScientificProcess/Data//106/570/1428/b24e634c-9e31-475d-ba25-f161f74e9cc1/Uploads/16849_CIRRINCIONE_VIDEO.mp4 Publication History Article published online: 27 March 2025 © 2025. European Society of Gastrointestinal Endoscopy. All rights reserved. Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

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