Endoscopic Papillary Large Balloon Dilation Combined with Guidewire-Assisted Precut Papillotomy for the Treatment of Choledocholithiasis in Patients with Billroth II Gastrectomy.
- Author:
Tae Nyeun KIM
1
;
Si Hyung LEE
Author Information
1. Division of Gastroenterology, Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, Korea. tnk@med.yu.ac.kr
- Publication Type:Original Article
- Keywords:
Precut;
Large balloon dilation;
Billroth II gastrectomy
- MeSH:
Bile Ducts;
Choledocholithiasis;
Gastrectomy;
Gastroenterostomy;
Hemorrhage;
Humans;
Lithotripsy;
Needles;
Pancreatitis
- From:Gut and Liver
2011;5(2):200-203
- CountryRepublic of Korea
- Language:English
-
Abstract:
BACKGROUND/AIMS: Endoscopic extraction of bile duct stones is difficult and often complicated in patients with a Billroth II gastrectomy. We evaluated a simpler technique to achieve an adequate ampullary opening for the removal of choledocholithiasis using endoscopic papillary large balloon dilation (EPLBD) combined with a guidewire-assisted needle-knife papillotomy. METHODS: Sixteen patients who had a Billroth II gastrectomy were included in this study. Following placement of the guidewire in the bile duct, a precut incision was made over the guidewire with a needle knife sphincterotome inserted alongside the guidewire. Balloon dilation of the ampullary orifice was gradually performed. RESULTS: Needle knife papillotomy over the guidewire with subsequent EPLBD was successful in all patients. Complete stone removal was achieved in 15 (93.7%) patients in 1 session. However, 1 (6.3%) patient required mechanical lithotripsy with an additional procedure for complete ductal clearance, and there was 1 case of minor bleeding following the EPLBD. There were no cases of pancreatitis or perforation. CONCLUSIONS: EPLBD followed by guidewire-assisted needle-knife papillotomy appears to be a useful method with few technical difficulties and a low risk of complications for the removal of bile duct stones in patients with prior Billroth II gastrectomy.
