title: 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).
abstract: 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.
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Pusan National University School of Medicine, Yangsan, Korea.
authors.forename: Gwang Ha
authors.initials: GH
authors.lastname: Kim
authors.forename: Dae Hwan
authors.initials: DH
authors.lastname: Kang
authors.forename: Geun Am
authors.initials: GA
authors.lastname: Song
authors.forename: Jeong
authors.initials: J
authors.lastname: Heo
authors.forename: Chan Ho
authors.initials: CH
authors.lastname: Park
authors.forename: Tae In
authors.initials: TI
authors.lastname: Ha
authors.forename: Kyung Yeob
authors.initials: KY
authors.lastname: Kim
authors.forename: Hye Jeong
authors.initials: HJ
authors.lastname: Lee
authors.forename: Il Doo
authors.initials: ID
authors.lastname: Kim
authors.forename: Seong Ho
authors.initials: SH
authors.lastname: Choi
authors.forename: Chul Soo
authors.initials: CS
authors.lastname: Song
mesh_terms: 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