Endoscopic removal of bile-duct stones by using a rotatable papillotome and a large-balloon dilator in patients with a Billroth II gastrectomy (with video).

BACKGROUND: Endoscopic stone removal is difficult in patients with a Billroth II gastrectomy.

OBJECTIVE: To evaluate the usefulness of a rotatable papillotome and large-balloon dilation for removing bile-duct stones in patients with a Billroth II gastrectomy.

DESIGN: A case series.

SETTING: A large tertiary-referral center.

PATIENTS AND INTERVENTION: Nine patients with bile-duct stones and a previous Billroth II gastrectomy were included. An endoscopic sphincterotomy (EST) was performed with a rotatable papillotome that could correct the axis of the cut toward the 5-o'clock direction; a large-balloon dilation (LBD) was then performed.

MAIN OUTCOME MEASUREMENTS: The ability to perform an EST in the desired direction, successful stone removal, and complications.

RESULTS: Rotation of the papillotome toward the 5-o'clock direction and an EST were achieved in 8 patients (89%). Stones were removed by EST and LBD in all 8 patients. There were no complications.

LIMITATION: A small sample size.

CONCLUSIONS: Limited EST by using a rotatable papillotome plus large-balloon dilation seemed to be safe, easy, and effective for removing bile-duct stones in patients with a Billroth II gastrectomy.