One-Step Transpapillary Balloon Dilation under Cap-Fitted Endoscopy without a Preceding Sphincterotomy for the Removal of Bile Duct Stones in Billroth II Gastrectomy
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Background/Aims: Endoscopic sphincterotomy may be limited in Billroth II gastrectomy because of diffi culty in orientating the duodenoscope and sphincterotome as a result of altered anatomy. This study was planned to investigate the effi cacy and safety of endoscopic transpapillary large balloon dilation (EPBD) without preceding sphincterotomy for removal of large CBD stones in Billroth II gastrectomy. Methods:Between March 2010 and February 2011, one-step EPBD under cap-fi tted forward-viewing endoscopy was performed in patients who had undergone Billroth II gastrectomy at two tertiary referral centers. Main outcome measurements were successful duct clearance and EPBD-related complications. Results: Successful access to major duodenal papilla was performed in 13 patients, but successful selective CBD cannulation was achieved in 12 patients (92.3%). Median maximum transverse stone size was 11.5 mm (10 to 14 mm). The mean number of stones was 2 (1-5). The median CBD diameter was 15 mm (12 to 19 mm). Mean procedure time from successful biliary access to complete stone removal was 17.8 min. Complete duct clearance was achieved in all patients. Four patients (33.3%) needed one more session of ERCP for removal of remnant stones. Asymptomatic hyperamylasemia in two patients and minor bleeding in another occurred. Conclusions: Without preceding sphincterotomy,one-step EPBD (≥10 mm) under cap-fitted forward-viewing endoscopy may be safe and effective for the removal of large stones (≥10 mm) with CBD dilatation in Billroth II gastrectomy.
Abstract
Background/Aims: Endoscopic sphincterotomy may be limited in Billroth II gastrectomy because of diffi culty in orientating the duodenoscope and sphincterotome as a result of altered anatomy. This study was planned to investigate the effi cacy and safety of endoscopic transpapillary large balloon dilation (EPBD) without preceding sphincterotomy for removal of large CBD stones in Billroth II gastrectomy. Methods:Between March 2010 and February 2011, one-step EPBD under cap-fi tted forward-viewing endoscopy was performed in patients who had undergone Billroth II gastrectomy at two tertiary referral centers. Main outcome measurements were successful duct clearance and EPBD-related complications. Results: Successful access to major duodenal papilla was performed in 13 patients, but successful selective CBD cannulation was achieved in 12 patients (92.3%). Median maximum transverse stone size was 11.5 mm (10 to 14 mm). The mean number of stones was 2 (1-5). The median CBD diameter was 15 mm (12 to 19 mm). Mean procedure time from successful biliary access to complete stone removal was 17.8 min. Complete duct clearance was achieved in all patients. Four patients (33.3%) needed one more session of ERCP for removal of remnant stones. Asymptomatic hyperamylasemia in two patients and minor bleeding in another occurred. Conclusions: Without preceding sphincterotomy,one-step EPBD (≥10 mm) under cap-fitted forward-viewing endoscopy may be safe and effective for the removal of large stones (≥10 mm) with CBD dilatation in Billroth II gastrectomy.
참고문헌 (23)
- Forbes A, "ERCP and sphincterotomy after Billroth II gastrectomy", Gut, 25, pp.971~974 (1984)
- Osnes M, "Endoscopic retrograde cholangiography and endoscopic papillotomy in patients with a previous Billroth-II resection", Gut, 27, pp.1193~1198 (1986)
- Hintze RE, "Endoscopic access to the papilla of Vater for endoscopic retrograde cholangiopancreatography in patients with billroth II or Roux-en-Y gastrojejunostomy", Endoscopy, 29, pp.69~73 (1997)
- Nakahara K, "Therapeutic endoscopic retrograde cholangiopancreatography using an anterior obliqueviewing endoscope for bile duct stones in patients with prior Billroth II gastrectomy", J Gastroenterol, 44, pp.212~217 (2009)
- Ersoz G, "Biliary sphincterotomy plus dilation with a large balloon for bile duct stones that are difficult to extract", Gastrointest Endosc, 57, pp.156~159 (2003)
- 방승민, "Endoscopic Papillary Balloon Dilation with Large Balloon after Limited Sphincterotomy for Retrieval of Choledocholithiasis", Yonsei Medical Journal, 47(6), pp.805~810 (2006), 연세대학교의과대학
- Heo JH, "Endoscopic sphincterotomy plus large-balloon dilation versus endoscopic sphincterotomy for removal of bile-duct stones", Gastrointest Endosc, 66, pp.720~726 (2007)
- Maydeo A, "Balloon sphincteroplasty for removing difficult bile duct stones", Endoscopy, 39, pp.958~961 (2007)
- Minami A, "Small sphincterotomy combined with papillary dilation with large balloon permits retrieval of large stones without mechanical lithotripsy", World J Gastroenterol, 13, pp.2179~2182 (2007)
- 천영국, "Large-diameter biliary orifice balloon dilation to aid in endoscopic bile duct stone removal: a multicenter series", GASTROINTESTINAL ENDOSCOPY, 67(7), pp.1046~1052, MOSBY-ELSEVIER
- Jeong S, "Endoscopic large-balloon sphincteroplasty without preceding sphincterotomy for the removal of large bile duct stones: a preliminary study", Gastrointest Endosc, 70, pp.915~922 (2009)
- Cotton PB, "Endoscopic sphincterotomy complications and their management: an attempt at consensus", Gastrointest Endosc, 37, pp.383~393 (1991)
- Bergman JJ, "A randomized trial of endoscopic balloon dilation and endoscopic sphincterotomy for removal of bile duct stones in patients with a prior Billroth II gastrectomy", Gastrointest Endosc, 53, pp.19~26 (2001)
- Park CH, "Cap-assisted ERCP in patients with a Billroth II gastrectomy", Gastrointest Endosc, 66, pp.612~615 (2007)
- van Buuren HR, "Needleknife sphincterotomy guided by a biliary endoprosthesis in Billroth II gastrectomy patients", Endoscopy, 27, pp.229~232 (1995)
- Hintze RE, "Endoscopic sphincterotomy using an S-shaped sphincterotome in patients with a Billroth II or Roux-en-Y gastrojejunostomy", Endoscopy, 29, pp.74~78 (1997)
- Al-Kawas FH, "A new approach to sphincterotomy in patients with Billroth II gastrectomy", Gastrointest Endosc, 43, pp.253~255 (1996)
- Kim GH, "Endoscopic removal of bileduct stones by using a rotatable papillotome and a large-balloon dilator in patients with a Billroth II gastrectomy (with video)", Gastrointest Endosc, 67, pp.1134~1138 (2008)
- Freeman ML, "Complications of endoscopic biliary sphincterotomy", N Engl J Med, 335, pp.909~918 (1996)
- Wilkinson ML, "Intestinal perforation after ERCP in Billroth II partial gastrectomy", Gastrointest Endosc, 40, pp.389~390 (1994)
- Bagci S, "Efficacy and safety of endoscopic retrograde cholangiopancreatography in patients with Billroth II anastomosis", Hepatogastroenterology, 52, pp.356~359 (2005)
- Itoi T, "Large balloon papillary dilation for removal of bile duct stones in patients who have undergone a billroth ii gastrectomy", Dig Endosc, 22(Suppl 1), pp.S98~S102 (2010)
- Prat F, "Endoscopic sphincteroclasy: a useful therapeutic tool for biliary endoscopy in Billroth II gastrectomy patients", Endoscopy, 29, pp.79~81 (1997)