Endoscopic removal of bile-duct stones by using a rotatable papillotome and a large-balloon dilator in patients with a Billroth II gastrectomy (with video)

Background

Endoscopic stone removal is difficult in patients with a Billroth II gastrectomy.

Objective

To evaluate the usefulness of a rotatable papillotome and large-balloon dilation for removing bile-duct stones in patients with a Billroth II gastrectomy.

Design

A case series.

Setting

A large tertiary-referral center.

Patients and Intervention

Nine patients with bile-duct stones and a previous Billroth II gastrectomy were included. An endoscopic sphincterotomy (EST) was performed with a rotatable papillotome that could correct the axis of the cut toward the 5-o'clock direction; a large-balloon dilation (LBD) was then performed.

Main Outcome Measurements

The ability to perform an EST in the desired direction, successful stone removal, and complications.

Results

Rotation of the papillotome toward the 5-o'clock direction and an EST were achieved in 8 patients (89%). Stones were removed by EST and LBD in all 8 patients. There were no complications.

Limitation

A small sample size.

Conclusions

Limited EST by using a rotatable papillotome plus large-balloon dilation seemed to be safe, easy, and effective for removing bile-duct stones in patients with a Billroth II gastrectomy.

Abbreviations: CBD, common bile duct, EBD, endoscopic balloon dilation, EST, endoscopic sphincterotomy, LBD, large-balloon dilation, PTBD, percutaneous transhepatic biliary drainage, RP, rotatable papillotome