title: Patients with bulbar papilla and choledocholithiasis and their endoscopic management.
abstract: OBJECTIVE
  This study presents the endoscopic management of twenty-one patients with biliary stones, deformity at the duodenal bulb, and a flat shaped papilla ectopically located at duodenal bulb.
  
  
  METHODS
  Most of the patients were male with a mean age of 53.9 +/- 9.6 years. In four (19%) of the 21 patients stenotic parts in the bulbus were dilated with TTS balloons, thus allowing ectopic papillae to be reached in all of the cases. Papillary orifice and distal CBD were dilated with balloons from 4 mm diameter and increasing the diameter of the balloons stepwise to 6 to 15 mm.
  
  
  RESULTS
  In 20 (95%) the patients, the stones could be extracted in either the first or subsequent endoscopy session as the cholangiography. In one patient, retroperitoneal perforation in the intrapancreatic segment of the CBD occured after dilatation of CBD with a 15 mm balloon, and an operation was necessary.
  
  
  CONCLUSIONS
  The shared features which may constitute a unique clinical entity of the presented cases are 1) male gender, 2) bulbar papilla, 3) flat appearance of the major papilla endoscopically 4) deformed bulbus, and 5) presence of stones in the CBD. Bile duct stones can be treated with endoscopic balloon dilatation of the distal CBD and papilla.
authors.affiliation: Ege University Hospital Gastroenterology Department, Bornova, Izmir, Turkey.
authors.forename: Galip
authors.initials: G
authors.lastname: Ersoz
authors.forename: Sinan
authors.initials: S
authors.lastname: Akay
authors.forename: Omer
authors.initials: O
authors.lastname: Ozutemiz
authors.forename: Oktay
authors.initials: O
authors.lastname: Tekesin
mesh_terms: D002404:Catheterization / Q000379:methods; D042883:Choledocholithiasis / Q000601:surgery*; D004386:Duodenum / Q000002:abnormalities*; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D016896:Treatment Outcome