Removal Of Bile Duct Stones Research Articles

Su1736 Is Spontaneous Pancreatic Stent (Ps) Migration a Predictor of Early Recurrent Symptoms in Patients With Suspected or Proven Sphincter of Oddi Dysfunction (SOD)?

Su1735 Risk Factors Related to Open Converted Cholecystectomy in Patients With Cholelithiasis After Endoscopic Removal of Choledocholithiasis Yong-Hwan Kwon*, Chang-MIN Cho, MIN Kyu Jung, Seongwoo Jeon Internal Medicine, Kyungpook National University medical center, Daegu, Republic of Korea Background and aims: Laparoscopic cholecystectomy (LC) has been established as the gold standard management for symptomatic patients with cholelithiasis. Sometimes, it is inevitable to convert to open cholecystectomy (OC) in patients who planned to LC. In patient with GB and CBD stones, endoscopic removal of CBD stone may cause inflammation that is associated with adhesion adjacent to gallbladder. It is related to open converted cholecystectomy (OCC). However, there are few studies about which factors related to endoscopic retrograde cholangiopancreatography (ERCP) may influence conversion to OC. The purpose of this study was to evaluate the risk factors related with OCC in patients who were planned to LC after endoscopic removal of choledocholithiasis (ERC). Patients and Methods: The data for all patients who underwent LC or OCC after endoscopic removal of bile duct stone at our institution between January 2001 and December 2010 were retrospectively reviewed. Factors predictive for conversion were analyzed. Results: Three hundred seven patients underwent endoscopic removal of choledocholithiasis followed by scheduled LC. Among them, 48 patients (15.6%) needed conversion to OC. The most common cause of conversion to OC was anatomical adhesion in operation field (37.5%). Cholecystitis (p!0.005), percutaneous transhepatic biliary drainage (PTBD) or percutaneous gallbladder drainage (PTGBD) (pZ0.005), mechanical lithotripsy (p!0.005), multiple stones (pZ0.011), and multiple endoscopic trials of stone removal (pZ0.006) were significantly related to conversion in univariate analysis. In multivariate analysis, cholecystitis (OR 2.844, 95%CI 1.301-6.214, pZ0.009), mechanical lithotripsy (OR 6.881, 95%CI 2.142-22.109, p!0.005), multiple stones (OR 2.308, 95%CI 1.1614.590, pZ0.017), and multiple trials of stone removal (OR 3.180, 95%CI 1.0209.916, pZ0.046) were associated with OCC. Analyzing the OCC-related risk factors according to the duration from ERC to LC, mechanical lithotripsy (OR 16.161, 95% CI 2.971-87.895, p!0.005), multiple stones (OR 3.400, 95%CI 1.095-10.556, pZ0.034), and multiple trials of ERC (OR 8.632, 95%CI 1.072-69.481, pZ0.043) were significantly related to OCC within 2 weeks. However, there was no significant risk factor for conversion to OC after 2 weeks. Conclusions: In patients who had combined choledocholithiasis and cholelithiasis, considering risk factors related to open conversion cholecystectomy will be helpful determining the timing of LC, and if the patients had these endoscopic related risk factors, it is better to delay LC after 2 weeks from ERCP. Table 1. The risk factors of LC and OC after ERC www.giejournal.org LC (N[259) OC (N[48) Univariate P value Multivariate P value Age (years old) 61.9 15.2 60.8 16.1 0.665 Gender 0.076 Male 151 (58.3%) 35 (72.9%)

Su1670 Efficacy and Safety of Endoscopic Papillary Large-Balloon Dilatation for Postoperative Intestinal Common Bile Duct Stone by Using Double Balloon-ERCP

Endoscopic papillary large balloon dilatation (EPLBD) combined with limited endoscopic sphinteroctomy (EST) have recently been reported to be effective and safe for removal of common bile duct stones. However, there have been few reports of EPLBD treatment using balloon-assisted enteroscopy in patients with post-operative intestine.

Su1610 A Comparative Study Between PTGBD and Etgd As a Bridge to Surgery in Patients With Acute Cholecystitis and a Suspicion of CBD Stone

To compare the technical feasibility, clinical and surgical outcomes between a single-step approach of endoscopic removal of common bile duct (CBD) stones with endoscopic transpapillary gallbladder drainage (ETGD group) and a two-step approach of endoscopic removal of CBD stones and percutaneous transhepatic gallbladder drainage (PTGBD group) as a bridge treatment before cholecystectomy, in patients with acute cholecystitis and a high suspicion of CBD stones.

Su1653 A Prospective Randomized Trial Comparing EUS Guided ERCP Without Fluoroscopy With Standard ERCP in Common Bile Duct Stone Removal: a Preliminary Report

ERCP is the cornerstone treatment of common bile duct stone (CBDS). EUS is highly accurate in CBDS detection. EUS guided ERCP without fluoroscopy (EGEWF) in CBDS was feasible in our pilot study. The efficacy of EUS guided ERCP CBDS removal without fluoroscopy compared with standard ERCP has not been fully assessed. Aims. 1. To compare the efficacy and safety of EGEWF with ERCP in CBDS removal. 2. The proportion of patients with CBDS that was suitable for EGEWF. Methods. Preliminary analysis of all patients scheduled for EUS with suspected CBDS from May 2013 to November 2013 was done.

Su1644 Implication of Liver Test Fluctuations Prior to ERCP for Bile Duct Stones

ERCP is the primary method of bile duct stone removal. Given procedural morbidity, it is reserved for those with intermediate to high probability of choledocholithiasis. It has been suggested that even in patients who meet these criterion ERCP may be reconsidered in those in whom liver tests decline during the time between presentation and the planned procedure. Inflection (fall-then-rise or rise-then-fall) and increase in liver tests have been proposed to represent persistent intraductal stones.

Endoscopic Papillary Balloon Dilation Versus Sphincterotomy for Removal of Small Common Bile Duct Stones in Young Patients: Unresolved Issues for an Expanding Technique

Endoscopic Papillary Balloon Dilation Versus Sphincterotomy for Removal of Small Common Bile Duct Stones in Young Patients: Unresolved Issues for an Expanding Technique

Delayed Endoscopic Papillary Large Balloon Dilation After Sphincterotomy for Removing Large Bile Duct Stones in Patients with Acute Cholangitis

Endoscopic papillary large balloon dilation (EPLBD) after an endoscopic sphincterotomy (EST) is an option for endoscopic removal of large common bile duct (CBD) stones. However, risks or fear of severe adverse events remain. Our aim was to compare the safety and efficacy of delayed EPLBD after EST with concurrent EST and EPLBD in patients with acute cholangitis by large CBD stones. A total of sixty-eight patients with acute cholangitis from large CBD stones were enrolled in this prospective observational study. Thirty-five patients underwent concurrent EST and EPLBD at the same session (group A). Thirty-three patients underwent only EST at the first session, and EPLBD with stone removal was performed during a second session (group B). The complete stone removal rate and adverse events rate were analyzed. Both groups resulted in similar outcomes in terms of overall successful stone removal (100% in both groups) and the use of additional lithotripsy (22.9% in group A and 24.2% in group B). Six patients (17.1%) in group A had procedural-related adverse events including one patient with death by perforation, one with significant bleeding, and four with pancreatitis, including one moderate grade. However, there was no procedure-related complication in group B (p < 0.05). Delayed EPLBD after EST may reduce complications associated with EPLBD and extraction of large bile duct stones in patients with acute cholangitis.

Dilation-Assisted Stone Extraction: Does One Balloon Fit All?

The story of dilation-assisted stone extraction is characterized by tragedy and triumph. Although initially proposed as a means to preserve the native state of the bile duct, controlled studies indicated that dilation without endoscopic sphincterotomy (EST) was associated with a high risk of pancreatitis [1, 2]. However, dilation after EST is a safe and effective means of treating large bile duct stones. In this month’s Digestive Diseases and Sciences, Li et al. [3] extend the use of this method to manage bile duct stones of all sizes. Although generalizability may be limited by the specific study population and techniques, the approach suggests exciting possibilities of more widespread potential application. Balloon dilation that facilitates bile duct stone removal was first espoused as a means of avoiding long-term exposure of the biliary tree to enteric contents. Nevertheless, a multicenter randomized controlled trial of balloon dilation versus EST revealed a concerning incidence of pancreatitis among those who underwent balloon dilation compared with those who underwent EST [2]. In addition, nearly half of these cases were severe and two study patients died. Further confirmatory work led investigators to conclude that balloon dilation was not appropriate for clinical practice [1]. Endoscopic biliary sphincterotomy combined with balloon and basket maneuvers enables removal of 85 % of bile duct stones [4]. Nevertheless, perivaterian diverticuli and other anatomic abnormalities of the papilla complicate removal [5]. Large or impacted concretions may also be difficult to retrieve. Although, for these refractory stones, intraductal and extracorporeal shock wave and intraductal laser lithotripsy have been used, these approaches require extensive technical expertise, are not widely available, and are time consuming [6–8]. A critical variation of papillary balloon dilation has been proposed for removal of difficult bile duct stones [9]. By dilating the papilla after endoscopic sphincterotomy, complete clearance of difficult bile duct stones was achieved for 93 % of patients without elevated incidence of pancreatitis [9]. Subsequent work has confirmed that balloon dilation after EST is of comparable efficacy and as safe as conventional approaches for removal of large bile duct stones, and may be less likely to result in complications [10–13]. It is postulated that the biliary sphincter separates the biliary orifice from the pancreatic orifice, directing the force of dilation predominantly toward the bile duct and away from the pancreas [13]. Large retrospective studies also suggest that EST combined with large balloon dilation requires less mechanical lithotripsy, and that the duration of the procedure is shorter [11, 12]. In their study, Li et al. randomized 462 patients with bile duct stones to small EST combined with balloon dilation (sEST ? EPBD) compared with EST. The study differed from previous controlled trials in that the number of subjects was much larger and that subjects bearing stones of all sizes were included. Consistent with previous work, complete stone removal and incidence of complications were equivalent in the sEST ? EPBD and EST groups. This prospective study also convincingly demonstrated that procedure and fluoroscopy duration are briefer for sEST ? EPBD, with reduced requirement for mechanical lithotripsy than EST. The authors contributed equally to all aspects of this project.

Biliary ascariasis: an uncommon cause for recurrent biliary colic after biliary sphincterotomy and common bile duct stone removal

Endoscopic retrograde cholangiography is the most commonly used technique for removal of common bile duct stones. Biliary sphincterotomy during the procedure facilitates stone retrieval from the common bile duct. However, sphincterotomy ablates the normal biliary sphincter mechanism. This facilitates duodeno-biliary reflex and can result in inward migration of luminal parasite into the biliary system. In areas where ascariasis is endemic there is an increased risk of biliary ascariasis in postbiliary sphincterotomy patients. We report an unusual case where a patient presented with recurrent biliary colic after cholecystectomy and common bile duct stone extraction and was diagnosed to have biliary ascariasis with the help of endoscopic ultrasound examination of the biliary system.

Large balloon dilation post endoscopic sphincterotomy in removal of difficult common bile duct stones: a literature review.

Endoscopic sphincterotomy (ES) is the standard therapy in common bile duct (CBD) stones extraction. Large stones (≥ 12 mm) or multiple stones extraction may be challenging after ES alone. Endoscopic sphincterotomy followed by large balloon dilation (ESLBD) has been described as an alternative to ES in these indications. Efficacy, safety, cost-effectiveness and technical aspects of the procedure have been here reviewed. PubMed and Google Scholar search resulted in forty-one articles dealing with CBD stone extraction with 12 mm or more dilation balloons after ES. ESLBD is at least as effective as ES, and reduces the need for additional mechanical lithotripsy. Adverse events rates are not statistically different after ESLBD compared to ES for pancreatitis, bleeding and perforation. However, particular attention should be paid in patients with CBD strictures, which is identified as a risk factor of perforation. ESLBD is slightly cost-effective compared to ES. A small sphincterotomy is usually performed, and may reduce bleeding rates compared to full sphincterotomy. Dilation is performed with 12-20 mm enteral balloons. Optimal inflation time is yet to be determined. The procedure can be performed safely even in patients with peri-ampullary diverticula and surgically altered anatomy. ESLBD is effective and safe in the removal of large CBD stones, however, small sphincterotomy might be preferred and CBD strictures should be considered as a relative contraindication.

Safety and Utility of Endoscopic Removal of Common Bile Duct Stones in the Elderly

Safety and Utility of Endoscopic Removal of Common Bile Duct Stones in the Elderly

Primary common bile duct closure after open exploration for choledocholithiasis

Background: Choledocholithiasis is the second-most common complication of cholecystolithiasis, occurring in approximately 10-15% of patients. For choledocholithiasis, there are two methods for CBD exploration to extract stones: either endoscopically, by endoscopic retrograde cholangiopancreatography (ERCP) with or without sphincterotomy, or surgically, by an open or laparoscopic method Open CBD exploration has been the principal treatment in many hospitals and is still considered the gold standard for the removal of CBD stones. Following common bile duct (CBD) exploration and stone removal, the choice for closure of the incised bile duct lies between primary closure and T-tube drainage. There are many papers reported by different authors, which support the direct closure of the duct immediately after exploration. The aim ofthis study was to assess the clinical short-term results and benefits of primary closure of the common bile duct after open choledochotomy for CBD calculi in a developing country like Egypt. Methods: Between December 2010 and December 2013; 74 patients with a radiological evidence of common bile duct stones were admitted and treated at the Gastrointestinal Surgery Unit, Main Alexandria University Hospitalin whom the common bile duct diameter was equal to or larger than 8 mm. Those associated with distal CBD strictures, multiple intrahepatic calculi, or malignancy were excluded After approval of local ethics committees, all patients included in this study were informed well about the operative procedure and an informed written consent was obtained from every patient before carrying the procedure. All patients' data, surgical procedures, complications and follow-up details were collected and analyzed Results: CBD exploration and stone removal followed by primary closure was performed in all patients. The mean age of patients was 55.3 ±15.7 years {range, 37-75 years). Most of the patients presented with biliary colic (74%). Sixty-seven patients {90%) had concomitant gallstones as evident by preoperative abdominal ultrasound The mean diameter of CBD was 12.3 ±3.2mm {range, 8-27mm). Themaximumnumberofstoneswas 14. The total complication rate was 54% (4174) and included wound infection with delayed wound healing and bileleakage. One patient had a bile leakage that subsided on the third postoperative day. There was no post­ operative biliary obstruction, residual stones, cholangitis, pancreatitis, biliary peritonitis or intra-abdominal collections. The mean postoperative hospital stay was 4.2 ± 1 days. There was no perioperativemortality. The mean durationof follow-up was 10.8 ± 3.2 months {range, 4-18 months). There was no recurrence of CBD stones or stricture of bile ducts observed during the follow up period and postoperative ultrasound findings were normal. Conclusion: Primary closure of the CBD after open choledochotomy for choledocholithiasis is safe, feasible and effective with shorter hospital stays and lower costs.

Clinical study of percutaneous transhepatic balloon dilation:a novel procedure for common bile duct stone

To investigate the safety and efficacy of percutaneous transhepatic balloon dilation for the removal of common bile duct stone. Sixty-eight cases with common bile duct stone treated with percutaneous transhepatic balloon dilation in our department from July 2008 to April 2011 were analyzed retrospectively.Record CA19-9, total bilirubin, indirect bilirubin and albumin before the procedure, 1 week and 1 month later. Check if immediate complications occurs, including hemorrhage, perforation, pancreatitis and cholangitis. During the following up for 2 years, stone recurrence, reflux cholangitis and other long-term complications were observed. Analyze the changes of indicators between preoperative and postoperative and the correlation. All of the 68 patients were treated successfully.53 patients underwent one procedure, and 15 patients received twice or more times of procedures. CA19-9, TBIL and IBIL decreased significantly 1 week later and 1 month later compared with those before the procedure, while ALB was opposite.Incidences of biliary tract infection, hemorrhage, and pancreatitis were 4.4% (3/68), 2.9% (2/68) and 1.5% (1/68) respectively.No severe complications occurred, including perforation of gastrointestinal or biliary tract.Incidences of recurrent stone and reflux cholangitis were 14.7% (10/68) and 5.9% (4/68) in two years after the procedure. Percutaneous transhepatic balloon dilation is a safe and effective procedure for patients with common bile duct stone. For the cases which could not be handled with endoscopic procedures, it provides a new therapeutic approach.

One-step Laparoscopic and Endoscopic Treatment of Gallbladder and Common Bile Duct Stones: Our Experience of the Last 9 Years in a Retrospective Study

The optimal timing and best method for removal of common bile duct stones (CBDS) associated with gallbladder stones (GBS) is still controversial. The aim of this study is to investigate the outcomes of a single-step procedure combining laparoscopic cholecystectomy (LC), intraoperative cholangiography (IOC), and endoscopic retrograde cholangiopancreatography (ERCP). Between January 2003 and January 2012, 1972 patients underwent cholecystectomy at our hospital. Of those, 162 patients (8.2%; male/female 72/90) presented with GBS and suspected CBDS. We treated 54 cases (Group 1) with ERCP and LC within 48 to 72 hours. In 108 patients (Group 2) we performed LC with IOC and, if positive, was associated with IO-ERCP and sphincterotomy. In Group 1, a preoperative ERCP and LC were completed in 50 patients (30%). In four cases (2%), an ERCP and endobiliary stents were performed without cholecystectomy and then patients were discharged because of the severity of clinical conditions and advanced American Society of Anesthesiologists score (III to IV). Two months later a preoperative ERCP and removal of biliary stents were performed followed by LC 48 to 72 hours later. In Group 2, the IOC was performed in all cases and CBDS were extracted in 94 patients (87%). In two cases, the laparoscopic choledochotomy was necessary to remove large stones. In another two cases, an open choledochotomy was performed to remove safely the stones with T-tube drainage. In three cases, conversion was necessary to safely complete the procedure. The mean operative time was 95 minutes (range, 45 to 150 minutes) in Group 1 and 130 minutes (range, 50 to 300 minutes) in Group 2. The mean hospital stay was 6.5 days (range, 4 to 21 days) in Group 1 and 4.7 days (range, 3 to 14 days) in Group 2. Five cases (two in Group 2 and three in Group 1) presented with CBDS at 12 to 18 months after surgery. They were treated successfully with a second ERCP. There was no perioperative mortality. Our experience suggests that when clinically and technically feasible, a single-stage approach combining LC, IOC, and ERCP to the patients diagnosed with chole-choledocholithiasis is indicated. The IO-ERCP with CBDS extraction is a safe and effective method with low risk of postoperative pancreatitis. One-step treatment is more comfortable for the patient and also reduces the mean hospital stay.

Comparison of Endoscopic Papillary Balloon Dilation and Sphincterotomy in Young Patients with CBD Stones and Gallstones

Endoscopic biliary sphincterotomy (EBS) results in permanent loss of sphincter function and its long-term complications are unknown. Endoscopic papillary balloon dilation (EPBD) is an alternative procedure that preserves sphincter function, although it is associated with a higher risk of pancreatitis than is EBS. The aim of this study was to evaluate the safety and outcomes of EPBD with limited indications for removal of common bile duct (CBD) stones combined with gallstones in patients younger than 40 years. Young (age < 40 years) patients who had CBD stones combined with gallstones on imaging studies were enrolled in this study. A total of 132 patients were randomly divided into the EPBD group (n = 62) or the EBS group (n = 70) for extraction of CBD stones. The ballooning size of EPBD ranged from 6 to 10 mm. Complete bile duct clearance was achieved in 98.4 % (61/62) of the EPBD group and 100 % (70/70) of the EBS group. Mechanical lithotripsy was required in 8.1 % (5/62) of the EPBD group and 8.6 % (6/70) of the EBS group. The early complication rates were 8.1 % (5/62) (five pancreatitis) in the EPBD group and 11.4 % (8/70) (five [7.1 %] pancreatitis, two bleeding and one perforation) in the EBS group. The recurrence rates of CBD stones were 1.6 % (1/62) in the EPBD group and 5.7 % (4/70) in the EBS group. EPBD with limited indications was safe and effective as EBS for removal of CBD stones combined with gallstones in young patients who had a longer life expectancy.

Dilation-Assisted Stone Extraction: An Alternative Method for Removal of Common Bile Duct Stones

Dilation-assisted stone extraction, also termed small endoscopic sphincterotomy (EST) plus endoscopic papillary balloon dilatation, is more efficient than EST alone for removal of large common bile duct (CBD) stones. However, whether this technique can be used for all stones is unclear. This study was designed to evaluate the efficacy and complications of dilation-assisted stone extraction for CBD stones. A total of 462 patients with CBD stones were randomized to undergo either dilation-assisted stone extraction (group A) or EST (group B). The efficacy and complications of the two techniques were compared. Groups A and B showed similar outcomes in terms of stone removal. The short-term and 1-year complication rates were also similar between the two groups. However, the first-session stone removal rate in group A was significantly higher than that in group B. Mechanical lithotripsy was required significantly more often in group B than in group A. The total procedure time and total fluoroscopy time in group A were significantly shorter than those in group B. Dilation-assisted stone extraction and EST are safe and effective techniques for the treatment of CBD stones. Dilation-assisted stone extraction has high efficiency. This technique is an alternative method for removal of CBD stones.

Laparoscopic Techniques for Safe and Successful Removal of Common Bile Duct Stones in Pediatric Patients

Choledocholithiasis is uncommon in the pediatric population. Techniques for common bile duct stone extraction are still not well established. This article aims to describe safe and applicable techniques for pediatric common bile duct exploration. This was a retrospective review of a prospectively maintained database of two pediatric surgeons for patients undergoing laparoscopic common bile duct exploration at two tertiary-care centers from April 2008 to March 2012. For 39 patients under 15 years of age undergoing laparoscopic cholecystectomy, 10 cholangiograms were performed, and 8 were found to have filling defects. Seven patients underwent successful laparoscopic common bile duct exploration with documentation of stone clearance, and 1 patient was sent for postoperative endoscopic retrograde cholangiopancreatography with stone extraction. Eleven patients had cholecystectomy performed by single-incision laparoscopic surgery, but none of these had cholangiograms or common bile duct explorations. Various methods of stone clearance were used, including the use of saline flush, balloon catheters, nitinol stone extractors, and the aide of glucagon. Depending on patient size, a choledochosope or a ureteroscope was used. There were no complications and no conversions to open surgery. Laparoscopic common bile duct exploration is feasible in the pediatric population, using many of the instruments readily available in the standard operating room. With an armamentarium of tools and techniques, the method of stone extraction can be tailored to the patient and situation.

Minimal Endoscopic Sphincterotomy with Papillary Large Balloon Dilation versus Endoscopic Sphincterotomy Alone for Large Common Bile Duct Stones Removal: A Comparative Meta-analysis

Purpose: Endoscopic sphincterotomy (ES) is the traditional technique for removal of stones from the bile duct. ES carries an increased risk of bleeding, perforation, bile duct stenosis and ascending cholangitis. Recently, minimal endoscopic sphincterotomy with large balloon dilation has been shown to be a safe and effective technique for the removal of large (diameter >10mm)or difficult common bile duct stones. However, comparison of ES and limited ES plus papillary large balloon dilatation (ESPLBD) for bile duct stone clearance has yielded inconsistent results. The purpose of this study is to compare the effect of ESPLBD Versus EST alone in the retrieval of CBD stones and post procedural complications. Methods: Two authors independently conducted a comprehensive search on Medline, PubMed, EMBase and the Cochrane Central Register of Controlled Trials (CENTRAL) for relevant articles on the subject. Only studies published in English were included in the analysis. A random effect meta-analysis was performed. Publication bias was assessed using Begg's and Egger's tests. Results: Six studies involving 767 individuals were included in the analysis. The mean age of study participants was similar in both study arms (70.29 Vs 70.1, P = 0.92) ESPLBD compared to ES had similar outcomes for overall (OR 1.0; 95% CI 0.98-1.03, P = 0.92), and stone clearance in the first ERCP session (OR 1.06; 95% CI 1.00-1.13). Table 1 summarizes the differences between each study arm with regards to stone clearance, and complications of procedure (post-ERCP pancreatitis, cholangitis, bleeding and perforation). Mechanical Lithotripsy was required more frequently in the ES group (OR 0.58; 95% CI 0.44-0.78, P <0.001). ESPLBD did not significantly increase the duration of the procedure. There was no statistically significant difference in number of stones (2.7 vs. 2.5; P 0.63), number of ERCPs required (2 vs. 2; P =0.70), stone size (17.18 vs. 17.24; P = 0.97) and diameter of CBD (17.6 vs. 17.72; P = 0.93) in both study arms. There was some evidence of heterogeneity for overall stone clearance but no evidence of publication bias. Conclusion: Minimal ESPLBD is an effective and safe alternative to EST alone for the removal of large common bile duct stones. ESPLBD reduces the need for mechanical lithotripsy but offers no additional advantage over EST alone in overall stone clearance or post procedural complications.

Balloon Papillary Dilation for Removal of Bile Duct Stones in Patients with Billroth II Gastrectomy

Balloon Papillary Dilation for Removal of Bile Duct Stones in Patients with Billroth II Gastrectomy

Endoscopic Papillary Balloon Dilation and Extraction of Bile Duct Stone

Endoscopic therapy is the first-line treatment for patients with common bile duct stones. Removing bile duct stones by endoscopic retrograde cholangiopancreaticography (ERCP) requires enlarging the papillary opening, either by cutting the biliary sphincter with an endoscopic sphincterotomy or by endoscopic papillary balloon dilation. Dilation has the advantage of sphincter preservation and a lower risk of hemorrhage, but carries an increased risk of post-ERCP pancreatitis. Although popular in Asia, in the Western world this technique is therefore reserved for patients with a major risk of bleeding or difficult anatomy. Here the technique of balloon dilation of the papillary sphincter is demonstrated in a patient with cholangiosepsis and septic coagulopathy. This article is part of an expert video encyclopedia.