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  • Title: 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).
    Author: Kim GH, Kang DH, Song GA, Heo J, Park CH, Ha TI, Kim KY, Lee HJ, Kim ID, Choi SH, Song CS.
    Journal: Gastrointest Endosc; 2008 Jun; 67(7):1134-8. PubMed ID: 18407269.
    Abstract:
    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.
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