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. 2012 Jan;6(1):113-7.
doi: 10.5009/gnl.2012.6.1.113. Epub 2012 Jan 12.

One-Step Transpapillary Balloon Dilation under Cap-Fitted Endoscopy without a Preceding Sphincterotomy for the Removal of Bile Duct Stones in Billroth II Gastrectomy

Tae Hoon Lee  1 , Jae Chul Hwang, Hyun Jong Choi, Jong Ho Moon, Young Deok Cho, Byung Moo Yoo, Sang-Heum Park, Jin Hong Kim, Sun-Joo Kim
Affiliations

One-Step Transpapillary Balloon Dilation under Cap-Fitted Endoscopy without a Preceding Sphincterotomy for the Removal of Bile Duct Stones in Billroth II Gastrectomy

Tae Hoon Lee et al. Gut Liver. 2012 Jan.

Abstract

Background/aims: Endoscopic sphincterotomy may be limited in Billroth II gastrectomy because of difficulty in orientating the duodenoscope and sphincterotome as a result of altered anatomy. This study was planned to investigate the efficacy and safety of endoscopic transpapillary large balloon dilation (EPBD) without preceding sphincterotomy for removal of large CBD stones in Billroth II gastrectomy.

Methods: Between March 2010 and February 2011, one-step EPBD under cap-fitted forward-viewing endoscopy was performed in patients who had undergone Billroth II gastrectomy at two tertiary referral centers. Main outcome measurements were successful duct clearance and EPBD-related complications.

Results: Successful access to major duodenal papilla was performed in 13 patients, but successful selective CBD cannulation was achieved in 12 patients (92.3%). Median maximum transverse stone size was 11.5 mm (10 to 14 mm). The mean number of stones was 2 (1-5). The median CBD diameter was 15 mm (12 to 19 mm). Mean procedure time from successful biliary access to complete stone removal was 17.8 min. Complete duct clearance was achieved in all patients. Four patients (33.3%) needed one more session of ERCP for removal of remnant stones. Asymptomatic hyperamylasemia in two patients and minor bleeding in another occurred.

Conclusions: Without preceding sphincterotomy, one-step EPBD (≥10 mm) under cap-fitted forward-viewing endoscopy may be safe and effective for the removal of large stones (≥10 mm) with CBD dilatation in Billroth II gastrectomy.

Keywords: Billroth II gastrectomy; Cap-fitted endoscopy; Common bile duct; Endoscopic balloon dilation; Stone.

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Conflict of interest statement

No potential conflict of interest relevant to this article was reported.

Figures

Fig. 1
Fig. 1
Endoscopic retrograde cholangiopancreatography showing the CRE wire-guided dilation, 12 mm in diameter.
Fig. 2
Fig. 2
The consecutive steps for the removal of common bile duct (CBD) stones under cap-fitted, forward-viewing endoscopy. Following the selective cannulation of the CBD using a guidewire-preloaded papillotome (A), CRE balloon dilation (12 mm in diameter) was maintained for 60 seconds (B). After dilating the major duodenal papilla, a large opening was noted (C), and the stones were removed by a retrieval balloon and mechanical lithotripter (D).
See this image and copyright information in PMC

References

    1. Forbes A, Cotton PB. ERCP and sphincterotomy after Billroth II gastrectomy. Gut. 1984;25:971–974. - PMC - PubMed
    1. Osnes M, Rosseland AR, Aabakken L. Endoscopic retrograde cholangiography and endoscopic papillotomy in patients with a previous Billroth-II resection. Gut. 1986;27:1193–1198. - PMC - PubMed
    1. Hintze RE, Adler A, Veltzke W, Abou-Rebyeh H. Endoscopic access to the papilla of Vater for endoscopic retrograde cholangio-pancreatography in patients with billroth II or Roux-en-Y gastro-jejunostomy. Endoscopy. 1997;29:69–73. - PubMed
    1. Nakahara K, Horaguchi J, Fujita N, et al. Therapeutic endoscopic retrograde cholangiopancreatography using an anterior oblique-viewing endoscope for bile duct stones in patients with prior Billroth II gastrectomy. J Gastroenterol. 2009;44:212–217. - PubMed
    1. Ersoz G, Tekesin O, Ozutemiz AO, Gunsar F. Biliary sphincterotomy plus dilation with a large balloon for bile duct stones that are difficult to extract. Gastrointest Endosc. 2003;57:156–159. - PubMed

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