Endoscopic stone removal using a scissors papillotome followed by papillary balloon dilation in patients with Billroth II gastrectomy – a case series

Introduction

The endoscopic removal of bile duct stones in patients with a previous Billroth II gastrectomy involves several obstacles in the approach to the ampulla of Vater, with selective cannulation and endoscopic sphincterotomy (EST) required for stone removal. EST in patients with a Billroth II gastrectomy remains a challenge to the biliary endoscopist because of technical difficulties and the fear of associated complications [1] [2] [3] [4] [5] [6].

Given these obstacles, endoscopic papillary balloon dilation (EPBD) has been suggested as an alternative method for the removal of bile duct stones in patients with a Billroth II gastrectomy. However, EPBD carries a risk for pancreatitis and is limited in its ability to remove large bile duct stones [7] [8] [9] [10] [11]. Recently, EPBD with a large-diameter balloon in conjunction with a preceding EST was reported as an effective modality for the endoscopic removal of bile duct stones [6] [12] [13].

Heiss et al. [14] introduced biliary sphincter scissors for precut access and described their advantages over a needle knife. We attempted EST using this scissors papillotome in patients with a Billroth II gastrectomy, and evaluated the feasibility and utility of the scissors in conjunction with EPBD for bile duct stone removal.

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