This clip demonstrates the gastroenteric anastomosis of a Billroth II anastomosis. Following the resection of the antrum and pylorus, a limb of small bowel is anastomosed to the body of the stomach to create the B II anastomosis. In a Billroth I, the duodenum is anastomosed to the gastric body. The B II creates an afferent or upstream limb and an efferent or downstream limb. The biliary and pancreatic drainage continues through the unchanged ampulla, down the afferent limb and into the gastric remnant often causing some degree of bile gastritis. Commonly performed in the pre H2 blocker era, this surgical procedure is now reserved for unusual cases of refractory ulcer disease or for resection of localized lesions. This anatomy does not appear to result in a significant increased risk of gastric adenocarcinoma. Endoscopic exam of this anatomy often requires inspection of the anastomotic ring as well as intubation of both limbs. PEG placement in the gastric remnant can often be performed if there is a antecolic gastroenteric anastomosis as opposed to a retrocolic anatomy.
Peter B. Kelsey, M.D., Harvard Medical School, Massachusetts General Hospital