Endoscopy 2009; 41(11): 993-996
DOI: 10.1055/s-0029-1215126
Case report

© Georg Thieme Verlag KG Stuttgart · New York

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

H.  J.  Choi1 , J.  H.  Moon1 , B.  M.  Ko1 , Y.  J.  Kim1 , Y.  K.  Cheon1 , Y.  D.  Cho1 , M.  S.  Lee1 , C.  S.  Shim1
  • 1Digestive Disease Center, Department of Internal Medicine, Soon Chun Hyang University School of Medicine, Bucheon, Korea
Further Information

Publication History

submitted5 April 2009

accepted after revision16 July 2009

Publication Date:
28 October 2009 (online)

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.

References

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J. H. MoonMD, PhD 

Digestive Disease Center
Soon Chun Hyang University School of Medicine
Soon Chun Hyang University Bucheon Hospital

1174 Jung-Dong
Wonmi-Ku
Bucheon 420–767
Korea

Fax: +82-32-6215080

Email: jhmoon@schbc.ac.kr