Value of CT for ERCP Endoscopists to Identify the Type of Gastroenteric Anastomosis in Patients with Previous Subtotal Gastrectomy.

UNLABELLED: Background/Aims: The aim of this study was to evaluate whether endoscopic retrograde cholangiopancreatography (ERCP) endoscopists can distinguish the type of gastroenteric anastomosis in patients with previous subtotal gastrectomy based on CT findings, particularly in biliary emergencies. METHODOLOGY: A total of 70 abdominal CT scans from patients who had undergone gastrectomy (n = 36, Billroth I; n = 34, Billroth II) were enrolled. The shuffled images were reviewed by 3 ERCP endoscopists blinded to clinical data. The endoscopists were asked to provide the most probable type of anastomosis. The sensitivity, specificity and interobserver agreement were analyzed for identifying Billroth II gastrectomy. RESULTS: The ERCP endoscopists were able to identify the type of anastomosis based on CT findings with a sensitivity, specificity and interobserver agreement of 100%, 97.2%, and 0.98, respectively. The key CT features for distinguishing Billroth II gastrectomy from Billroth I gastrectomy were: i) loss of continuity between the remnant stomach and duodenum; ii) less distended duodenal bulb; iii) the presence of a closed duodenal stump with surgical staples and iv) the presence of continuity between the remnant stomach and the jejunum. CONCLUSIONS: ERCP endoscopists were able to use CT findings to distinguish the type of gastroenteric anastomosis in patients with previous gastrectomy.