Endoscopic removal of bile-duct stones by using a rotatable papillotome and a large-balloon dilator in patients with a Billroth II gastrectomy (with video)

• Published in: Gastrointestinal endoscopy Vol. 67; no. 7; pp. 1134 - 1138
• Main Authors: Kim, Gwang Ha, MD, Kang, Dae Hwan, MD, Song, Geun Am, MD, Heo, Jeong, MD, Park, Chan Ho, MD, Ha, Tae In, MD, Kim, Kyung Yeob, MD, Lee, Hye Jeong, MD, Kim, Il Doo, MD, Choi, Seong Ho, MD, Song, Chul Soo, MD
• Format: Journal Article
• Language: English
• Published: New York, NY Mosby, Inc 01.06.2008; Elsevier
• Subjects: Aged; Aged, 80 and over; Biological and medical sciences; Catheterization - instrumentation; Catheterization - methods; Cholangiopancreatography, Endoscopic Retrograde - instrumentation; Cholangiopancreatography, Endoscopic Retrograde - methods; Choledocholithiasis - complications; Choledocholithiasis - diagnosis; Choledocholithiasis - therapy; Combined Modality Therapy; Digestive system. Abdomen; Endoscopy; Female; Follow-Up Studies; Gastrectomy - methods; Gastroenterology and Hepatology; Gastroenterology. Liver. Pancreas. Abdomen; Gastroenterostomy - methods; Humans; Investigative techniques, diagnostic techniques (general aspects); Liver. Biliary tract. Portal circulation. Exocrine pancreas; Male; Medical sciences; Middle Aged; Other diseases. Semiology; Postoperative Complications - physiopathology; Risk Assessment; Sphincterotomy, Endoscopic - instrumentation; Sphincterotomy, Endoscopic - methods; Stomach Neoplasms - complications; Stomach Neoplasms - diagnosis; Stomach Neoplasms - surgery; Stomach, duodenum, intestine, rectum, anus; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the digestive system; Treatment Outcome; large-balloon dilation; PTBD; CBD; percutaneous transhepatic biliary drainage; common bile duct; EBD; EST; rotatable papillotome; endoscopic balloon dilation; endoscopic sphincterotomy; RP; LBD; Human; Billroth II operation; Endoscopic surgery; Choledocolithiasis; Treatment; Digestive diseases; Biliary tract disease; Gastrectomy
• ISSN: 0016-5107; 1097-6779
• DOI: 10.1016/j.gie.2007.12.016

Background Endoscopic stone removal is difficult in patients with a Billroth II gastrectomy. Objective To evaluate the usefulness of a rotatable papillotome and large-balloon dilation for removing bile-duct stones in patients with a Billroth II gastrectomy. Design A case series. Setting A large tertiary-referral center. Patients and Intervention Nine patients with bile-duct stones and a previous Billroth II gastrectomy were included. An endoscopic sphincterotomy (EST) was performed with a rotatable papillotome that could correct the axis of the cut toward the 5-o'clock direction; a large-balloon dilation (LBD) was then performed. Main Outcome Measurements The ability to perform an EST in the desired direction, successful stone removal, and complications. Results Rotation of the papillotome toward the 5-o'clock direction and an EST were achieved in 8 patients (89%). Stones were removed by EST and LBD in all 8 patients. There were no complications. Limitation A small sample size. Conclusions Limited EST by using a rotatable papillotome plus large-balloon dilation seemed to be safe, easy, and effective for removing bile-duct stones in patients with a Billroth II gastrectomy.