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.
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.
Authors: Jin Ho Lee; Dae Hwan Kang; Jong Hwan Park; Min Dae Kim; Ki Tae Yoon; Cheol Woong Choi; Hyung Wook Kim; Mong Cho Journal: Gut Liver Date: 2010-03-25 Impact factor: 4.519