title: Endoscopic papillary large balloon dilation in Billroth II gastrectomy patients with bile duct stones.
abstract: OBJECTIVE
  Patients with Billroth II (B-II) gastrectomy present technical difficulties during endoscopic stone removal due to altered anatomy. Although endoscopic sphincterotomy alone or endoscopic balloon dilation alone has been used for removal of bile duct stones in patients with B-II gastrectomy, the results are not satisfactory. The aim of this study was to evaluate the efficacy and safety of endoscopic papillary large balloon dilation (EPLBD) for removal of bile duct stones in patients with B-II gastrectomy.
  
  
  METHODS
  Twenty-six patients (20 men and six women; median age 72 years) with bile duct stones and a history of B-II gastrectomy were enrolled. After cannulation, limited endoscopic sphincterotomy was performed. Then, balloon dilation (balloon size, 10-15 mm) was performed and stones were removed conventionally or via mechanical lithotripsy. Successful stone removal and complications were evaluated.
  
  
  RESULTS
  In all cases, stones were successfully removed. The median number of sessions for complete stone removal was one (range 1-3). Stone removal by mechanical lithotripsy was achieved in three patients (11.5%). There were no significant complications, such as bleeding, pancreatitis, or perforation.
  
  
  CONCLUSIONS
  Endoscopic papillary large balloon dilation is an effective and safe method for removal of bile duct stones. We suggest consideration of this technique for removal of bile duct stones in patients with B-II gastrectomy.
authors.affiliation: Department of Internal Medicine, Pusan National University School of Medicine, Yangsan, Korea.
authors.forename: Cheol Woong
authors.initials: CW
authors.lastname: Choi
authors.forename: Jung Sik
authors.initials: JS
authors.lastname: Choi
authors.forename: Dae Hwan
authors.initials: DH
authors.lastname: Kang
authors.forename: Bong Gap
authors.initials: BG
authors.lastname: Kim
authors.forename: Hyung Wook
authors.initials: HW
authors.lastname: Kim
authors.forename: Su Bum
authors.initials: SB
authors.lastname: Park
authors.forename: Ki Tae
authors.initials: KT
authors.lastname: Yoon
authors.forename: Mong
authors.initials: M
authors.lastname: Cho
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002404:Catheterization / Q000009:adverse effects; D016009:Chi-Square Distribution; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects; D005260:Female; D042882:Gallstones / Q000628:therapy*; D005743:Gastrectomy / Q000009:adverse effects*; D006801:Humans; D008096:Lithotripsy; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D056910:Republic of Korea; D016717:Sphincterotomy, Endoscopic / Q000009:adverse effects; D016896:Treatment Outcome