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.
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.
Jeong
Eul Jo
EJ
Department of Internal Medicine, Pusan National University School of Medicine, Yangsan, Busan, Korea.
Kang
Dae Hwan
DH
Kim
Dong Uk
DU
Choi
Cheol Woong
CW
Eum
Jae Sup
JS
Jung
Woo Jin
WJ
Kim
Pyo Jun
PJ
Kim
Yong Wuk
YW
Jung
Kyung Sik
KS
Bae
Yong Mok
YM
Cho
Mong
M
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