Retrieval Of Bile Duct Stones Research Articles

Endoscopic papillary large balloon dilation for the retrieval of bile duct stones after prior Billroth II gastrectomy

Background/Aims:Endoscopic retrieval of large common bile duct (CBD) stones is often difficult in patients who have undergone Billroth II gastrectomy, as anatomic alterations may present technical barriers to successful cannulation and increase procedure-related complications. Endoscopic papillary large balloon dilation (EPLBD) can be an alternative technique for the removal of difficult stones. Accordingly, the aim of this study was to evaluate the safety and effectiveness of EPLBD for CBD stone extraction in patients with Billroth II gastrectomy.Materials and Methods:From July 2006 to November 2011, 30 patients who underwent EPLBD with limited endoscopic sphincterotomy (EPLBD + ES) or EPLBD alone for the treatment of large CBD stones (≥10 mm) after Billroth II gastrectomy were retrospectively reviewed. A large balloon dilator (12-18 mm) was used to dilate the ampullary orifice.Results:Selective cannulation was successful in 25 patients (83.3%) with a standard catheter. Of the 30 subjects, EPLBD + ES was performed in 19 and EPLBD alone in 11. The mean bile duct diameter was 17.7 ± 4.3 mm (range, 11-31 mm), and mean size of balloon dilation was 14.5 ± 2.6 mm (range, 12-18 mm). Stone removal was successfully completed in 29 patients (96.7%). Successful stone retrieval during the first session was achieved in 27 patients (90.0%). Two cases (6.7%) of mild pancreatitis responded to conservative treatment, and no perforation or mortality was encountered.Conclusions:EPLBD with or without needle knife (NK) sphincterotomy seems to be a safe and feasible modality for CBD stone retrieval in patients with prior Billroth II gastrectomy.

Endoscopic Papillary Balloon Dilation with Large Balloon after Limited Sphincterotomy for Retrieval of Choledocholithiasis

Endoscopic papillary balloon dilation (EBD) for choledocholithiasis is known to be comparable to endoscopic sphincterotomy (EST) especially in cases of small stones. With larger stones, EBD with conventional balloon, which have a diameter of 6-8 mm, was reported as less effective for extraction of stones. We evaluated the efficacy and complications of EBD with large balloons (10-15 mm) after limited EST for retrieval of choledocholithiasis. From February 2005, we have performed EBD with limited EST for retrieval of common bile duct (CBD) stones. The patients who admitted with hyperamylasemia and gallstone pancreatitis were excluded. In cases without CBD dilation, EPBD with 12 mm for 40 seconds was performed. And in cases with CBD dilation, we dilated the sphincters with 15 mm sized balloon for 40 seconds. Total 22 patients (11 of male) were performed EBD with limited EST for retrieval of CBD stones. The median diameter of the stones was 10 mm (5-25 mm). Ten cases had multiple stones and 6 cases periampullary diverticuli. Successful stone removal in the initial session of ERCP with EBD was accomplished in 16 patients (72.7%). And complete retrieval of bile duct stones was achieved in all patients with repeated ERCP. In the aspect of complications, any episodes of perforation, bleeding was not developed. Only one case of mild grade of post-procedural pancreatitis was noted. However, post-procedural hyperamylasemia was developed in 16 cases (68.2%). EBD with larger balloon seems to be a feasible and safe alternative technique for conventional EST in CBD stone extraction.

Single-centre audit of endoscopic common bile duct stone retrieval

Abstract Background Endoscopic extraction of stones in the bile duct is not without risk, with complications occurring in up to 10 per cent of patients. The aim of this study was to determine the success and complications of stone retrieval by endoscopic retrograde cholangiopancreatography (ERCP) in this institution. Methods This was a retrospective analysis of a prospective database for all ERCPs (single operator, single institution) between 1990 and 1995. Some 271 consecutive patients with a strong suspicion of bile duct stones, from history or investigations, were studied. All patients underwent ERCP and attempted retrieval of bile duct stones if detected. Treatment success was strictly defined as a stone-free postprocedure radiograph. All patients were followed to identify complications occurring within 30 days of the procedure. Results The median age of the 271 patients was 73 (range 17–96) years; 62 per cent were women. Some 139 patients had 162 significant other medical conditions (61 per cent cardiopulmonary) that required specialist treatment. The presenting symptoms included painful jaundice (34 per cent), acute pancreatitis (25 per cent), cholangitis (17 per cent), painless jaundice (14 per cent) and abdominal pain alone (9 per cent). Stones were seen at ERCP in 192 patients (71 per cent); the median number of stones was 1 (range 0–20). Successful endoscopic stone retrieval was achieved in 136 patients (71 per cent) at the first attempt, with an overall success rate of 90 per cent. The median number of ERCPs per patient was 1 (range 1–4). There were five false-negative ERCPs (2 per cent) and 19 retrieval failures (10 per cent), which included requirement for percutaneous cholangiography or endoscopic stenting for successful treatment. Complications occurred in eight␣patients (3 per cent), and included cholangitis (1␣per cent), pancreatitis (less than 1 per cent) and haemorrhage (less than 1 per cent). There were two procedure-related deaths (1 per cent), from myocardial infarction and cholangitis. Conclusion Endoscopic stone retrieval can be achieved successfully with low morbidity and mortality rates, even in patients with significant co-morbidity. These data provide further support for dedicated units offering a regional ERCP service.