Publication Name	World Journal of Gastrointestinal Surgery
Manuscript ID	125027
DOI	10.4240/wjgs.125027
Country	China

Category	Gastroenterology & Hepatology
Manuscript Type	Retrospective Cohort Study
Article Title	Access before cannulation: Stage-based failure patterns during unsuccessful endoscopic retrograde cholangiopancreatography in Billroth II anatomy
Manuscript Source	Unsolicited Manuscript
All Author List	Yong-Bin Deng, Yu-Chieh Weng, He-Qing Chen, Han-Xu Zhuang, Hui Pu, Yong Xu, De-Jin Zhong, Wei-Ting Chen, Yang-Bor Lu and Ya-Dong Lai
Funding Agency and Grant Number	Funding Agency Grant Number Natural Science Foundation Projects No. 3502Z20227374 and No. 3502Z20227377 Xiamen Science and Technology Project No. 3502Z20224ZD1124
Corresponding Author	Ya-Dong Lai, Chief, Chief Physician, MD, Department of Gastroenterology, Zhangzhou Affiliated Hospital of Fujian Medical University, No. 59 Shengli West Road, Zhangzhou 363000, Fujian Province, China. lyd0596@hotmail.com
Key Words	Billroth II gastrectomy; Surgically altered anatomy; Cap-assisted forward-viewing endoscopy; Intervention failure; Biliary drainage
Core Tip	In this single-center retrospective cohort of seventy-four patients with Billroth II anatomy and a native papilla undergoing cap-assisted forward-viewing endoscopic retrograde cholangiopancreatography, most failures occurred before the papilla was reached. Overall intervention success was 77%, increasing to 92% once the papilla was reached, identifying afferent-limb navigation as the principal procedural bottleneck. Exploratory regression estimates suggested greater failure odds with a malignant indication for the original Billroth II surgery and lower odds with choledocholithiasis-related biliary disease, although uncertainty remained. These hypothesis-generating findings may inform anatomy- and indication-aware procedural planning.
Citation	Deng YB, Weng YC, Chen HQ, Zhuang HX, Pu H, Xu Y, Zhong DJ, Chen WT, Lu YB, Lai YD. Access before cannulation: Stage-based failure patterns during unsuccessful endoscopic retrograde cholangiopancreatography in Billroth II anatomy. World J Gastrointest Surg 2026; In press DOI: https://doi.org/10.4240/wjgs.125027
PDF	125027-in-press.pdf

Received	2026-07-02 05:52
Peer-Review Started	2026-07-02 05:53
First Decision by Editorial Office Director
Return for Revision	2026-08-03 07:28
Revised	2026-08-13 04:58
Publication Fee Transferred	2026-08-23 04:44
Second Decision by Editor	2026-10-19 06:06
Second Decision by Editor-in-Chief
Final Decision by Editorial Office Director	2026-10-20 09:44
Articles in Press	2026-10-20 09:44
Edit the Manuscript by Language Editor
Typeset the Manuscript

ISSN	1948-9366 (online)
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