Gut Liver.  2012 Jan;6(1):113-117.

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

• Lee TH
• Hwang JC
• Choi HJ
• Moon JH
• Cho YD
• Yoo BM
• Park SH
• Kim JH
• Kim SJ

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 (> or =10 mm) under cap-fitted forward-viewing endoscopy may be safe and effective for the removal of large stones (> or =10 mm) with CBD dilatation in Billroth II gastrectomy.

Keyword

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

MeSH Terms

Ampulla of Vater
Bile
Bile Ducts
Catheterization
Cholangiopancreatography, Endoscopic Retrograde
Common Bile Duct
Dilatation
Duodenoscopes
Endoscopy
Gastrectomy
Gastroenterostomy
Hemorrhage
Humans
Hyperamylasemia
Sphincterotomy, Endoscopic
Tertiary Care Centers