Endoscopic Papillary Large Balloon Dilation Combined with Guidewire-Assisted Precut Papillotomy for the Treatment of Choledocholithiasis in Patients with Billroth II Gastrectomy

Background/Aims: Endoscopic extraction of bile duct stones is difficult and often complicated in patients with a Billroth II gastrectomy. We evaluated a simpler technique to achieve an adequate ampullary opening for the removal of choledocholithiasis using endoscopic papillary large balloon dilation...

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Bibliographic Details
Published in:Gut and liver 2011-06, Vol.5 (2), p.200
Main Authors: Tae Nyeun Kim, Si Hyung Lee
Format: Article
Language:Korean
Subjects:
Billroth II gastrectomy
Large balloon dilation
Precut
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Summary:Background/Aims: Endoscopic extraction of bile duct stones is difficult and often complicated in patients with a Billroth II gastrectomy. We evaluated a simpler technique to achieve an adequate ampullary opening for the removal of choledocholithiasis using endoscopic papillary large balloon dilation (EPLBD) combined with a guidewire-assisted needleknife papillotomy. Methods: Sixteen patients who had a Billroth II gastrectomy were included in this study. Following placement of the guidewire in the bile duct, a precut incision was made over the guidewire with a needle knife sphincterotome inserted alongside the guidewire. Balloon dilation of the ampullary orifice was gradually performed. Results: Needle knife papillotomy over the guidewire with subsequent EPLBD was successful in all patients. Complete stone removal was achieved in 15 (93.7%) patients in 1 session. However, 1 (6.3%) patient required mechanical lithotripsy with an additional procedure for complete ductal clearance, and there was 1 case of minor bleeding following the EPLBD. There were no cases of pancreatitis or perforation. Conclusions: EPLBD followed by guidewire-assisted needle-knife papillotomy appears to be a useful method with few technical diffi culties and a low risk of complications for the removal of bile duct stones in patients with prior Billroth II gastrectomy. (Gut Liver 2011;5:200-203)
ISSN:1976-2283