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).
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.


METHODS
A case series.


METHODS
A large tertiary-referral center.


METHODS
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.


METHODS
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.


CONCLUSIONS
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.
Kim
Gwang Ha
GH
Division of Gastroenterology, Department of Internal Medicine, Pusan National University School of Medicine, Yangsan, Korea.
Kang
Dae Hwan
DH
Song
Geun Am
GA
Heo
Jeong
J
Park
Chan Ho
CH
Ha
Tae In
TI
Kim
Kyung Yeob
KY
Lee
Hye Jeong
HJ
Kim
Il Doo
ID
Choi
Seong Ho
SH
Song
Chul Soo
CS
D000368:Aged; D000369:Aged, 80 and over; D002404:Catheterization / Q000295:instrumentation / Q000379:methods; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000295:instrumentation* / Q000379:methods; D042883:Choledocholithiasis / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy / Q000379:methods; D005763:Gastroenterostomy / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000503:physiopathology; D018570:Risk Assessment; D016717:Sphincterotomy, Endoscopic / Q000295:instrumentation / Q000379:methods*; D013274:Stomach Neoplasms / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D016896:Treatment Outcome; D014741:Video Recording