Billroth II gastrektomili hastalarda koledok taşlarının temizlenmesi için kısmi biliyer sfinkterotomi ile birlikte "large" balon dilatasyonun etkinliği

Abstract

Background/aims: Patients with Billroth II gastrectomy, who have modified anatomy of the gastrointestinal tract, present technical difficulties during endoscopic stone removal. Recently, a large balloon dilatation has been used especially for extraction of difficult bile duct stones after endoscopic sphincterotomy. The aim of this study was to evaluate the efficacy and safety of endoscopic papillary large balloon dilatation with limited endoscopic sphincterotomy for removal of bile duct stones in patients with Billroth II gastrectomy. Methods: Twelve patients (12 men; median age: 69 years) with bile duct stones and a history of Billroth II gastrectomy were enrolled. After cannulation, limited endoscopic sphincterotomy was performed. Then, a large balloon dilatation (balloon size, 12-18 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 removed successfully. 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 dilatation after endoscopic sphincterotomy appears to be an effective and safe method for removal of difficult bile duct stones in patients with Billroth II.