title: One-Step Transpapillary Balloon Dilation under Cap-Fitted Endoscopy without a Preceding Sphincterotomy for the Removal of Bile Duct Stones in Billroth II Gastrectomy.
abstract: OBJECTIVE
  Endoscopic sphincterotomy may be limited in Billroth II gastrectomy because of difficulty in orientating the duodenoscope and sphincterotome as a result of altered anatomy. This study was planned to investigate the efficacy and safety of endoscopic transpapillary large balloon dilation (EPBD) without preceding sphincterotomy for removal of large CBD stones in Billroth II gastrectomy.
  
  
  METHODS
  Between March 2010 and February 2011, one-step EPBD under cap-fitted forward-viewing endoscopy was performed in patients who had undergone Billroth II gastrectomy at two tertiary referral centers. Main outcome measurements were successful duct clearance and EPBD-related complications.
  
  
  RESULTS
  Successful access to major duodenal papilla was performed in 13 patients, but successful selective CBD cannulation was achieved in 12 patients (92.3%). Median maximum transverse stone size was 11.5 mm (10 to 14 mm). The mean number of stones was 2 (1-5). The median CBD diameter was 15 mm (12 to 19 mm). Mean procedure time from successful biliary access to complete stone removal was 17.8 min. Complete duct clearance was achieved in all patients. Four patients (33.3%) needed one more session of ERCP for removal of remnant stones. Asymptomatic hyperamylasemia in two patients and minor bleeding in another occurred.
  
  
  CONCLUSIONS
  Without preceding sphincterotomy, one-step EPBD (≥10 mm) under cap-fitted forward-viewing endoscopy may be safe and effective for the removal of large stones (≥10 mm) with CBD dilatation in Billroth II gastrectomy.
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Digestive Disease Center, Soonchunhyang University College of Medicine, Cheonan, Korea.
authors.forename: Tae Hoon
authors.initials: TH
authors.lastname: Lee
authors.forename: Jae Chul
authors.initials: JC
authors.lastname: Hwang
authors.forename: Hyun Jong
authors.initials: HJ
authors.lastname: Choi
authors.forename: Jong Ho
authors.initials: JH
authors.lastname: Moon
authors.forename: Young Deok
authors.initials: YD
authors.lastname: Cho
authors.forename: Byung Moo
authors.initials: BM
authors.lastname: Yoo
authors.forename: Sang-Heum
authors.initials: SH
authors.lastname: Park
authors.forename: Jin Hong
authors.initials: JH
authors.lastname: Kim
authors.forename: Sun-Joo
authors.initials: SJ
authors.lastname: Kim