title: Percutaneous transhepatic choledochoscopic lithotomy as a rescue therapy for removal of bile duct stones in Billroth II gastrectomy patients who are difficult to perform ERCP.
abstract: BACKGROUND
  Endoscopic retrograde cholangiopancreatography (ERCP) is more difficult and dangerous in patients with Billroth II (B II) gastrectomy than those with normal anatomy.
  
  
  OBJECTIVE
  To evaluate the clinical efficacy of percutaneous transhepatic choledochoscopic lithotomy (PTCSL) for removing common bile duct stones in B II gastrectomy patients who are difficult to perform ERCP.
  
  
  METHODS
  This study was designed as prospectively uncontrolled in a large tertiary referral center. In 20 patients, mostly men, with bile duct stones and an earlier B II gastrectomy, PTCSL was tried because of failed ERCP and high risk. The PTCSL was performed using electrohydraulic lithotripsy or papillary balloon dilation. Successful stone removal and complications were measured.
  
  
  RESULTS
  Stone removal was achieved in all 20 patients. The mean number of procedures and session time were 4.5 and 45 min, respectively. Minor PTCSL-related complications, such as fever, hemobilia, hyperamylasemia, and wound pain, occurred in five patients (25%). There were no major procedure-related complications, including perforation or mortality.
  
  
  CONCLUSIONS
  The PTCSL procedure is an effective and safe rescue therapy for common bile duct stones in B II gastrectomy patients with failed ERCP and high risk.
authors.affiliation: Department of Internal Medicine, Pusan National University School of Medicine, Yangsan, Busan, Korea.
authors.forename: Eul Jo
authors.initials: EJ
authors.lastname: Jeong
authors.forename: Dae Hwan
authors.initials: DH
authors.lastname: Kang
authors.forename: Dong Uk
authors.initials: DU
authors.lastname: Kim
authors.forename: Cheol Woong
authors.initials: CW
authors.lastname: Choi
authors.forename: Jae Sup
authors.initials: JS
authors.lastname: Eum
authors.forename: Woo Jin
authors.initials: WJ
authors.lastname: Jung
authors.forename: Pyo Jun
authors.initials: PJ
authors.lastname: Kim
authors.forename: Yong Wuk
authors.initials: YW
authors.lastname: Kim
authors.forename: Kyung Sik
authors.initials: KS
authors.lastname: Jung
authors.forename: Yong Mok
authors.initials: YM
authors.lastname: Bae
authors.forename: Mong
authors.initials: M
authors.lastname: Cho
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002760:Cholangiopancreatography, Endoscopic Retrograde; D042883:Choledocholithiasis / Q000601:surgery*; D000075202:Contraindications; D016145:Endoscopy, Digestive System / Q000009:adverse effects / Q000379:methods*; D005260:Female; D005743:Gastrectomy; D006801:Humans; D008096:Lithotripsy / Q000379:methods; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D016896:Treatment Outcome