Endoscopic Large-Diameter Balloon Dilation after Fistulotomy for the Removal of Bile Duct Stones in a Patient with Billroth II Gastrectomy

Ho Seok Ki; Seon Young Park; Kyung Won Yoon; Min Hyung Kim; Hyun Soo Kim; Sung Kyu Choi; Jong Sun Rew

doi:10.4068/cmj.2010.46.1.62

Journal List > Chonnam Med J > v.46(1) > 1017969

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Ki, Park, Yoon, Kim, Kim, Choi, and Rew: Endoscopic Large-Diameter Balloon Dilation after Fistulotomy for the Removal of Bile Duct Stones in a Patient with Billroth II Gastrectomy

Case Report

Chonnam Medical Journal

Chonnam Medical Journal 2010; 46(1): 62-66.

Published online: 15 April 2010

DOI: https://doi.org/10.4068/cmj.2010.46.1.62

Endoscopic Large-Diameter Balloon Dilation after Fistulotomy for the Removal of Bile Duct Stones in a Patient with Billroth II Gastrectomy

Ho Seok Ki, Seon Young Park, Kyung Won Yoon, Min Hyung Kim, Hyun Soo Kim, Sung Kyu Choi, Jong Sun Rew

Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea.

Corresponding Author (jsrew@chonnam.ac.kr)

Received 5 January 2010 Accepted 14 January 2010

Abstract

Endoscopic retrograde cholangiopancreatography (ERCP) is difficult to perform in patients with a Billroth II gastrectomy because of anatomical changes. The success rate of ERCP and endoscopic sphincterotomy in patients with a Billroth II gastrectomy is lower than that in patients with normal anatomy. In our case, a 76-year-old man with altered anatomy after a Billroth II gastrectomy underwent cap-assisted forward-viewing endoscopic cholangiopancreatography because of bile duct stones. We successfully performed a fistulotomy followed by large-diameter balloon dilation of the fistulotomy tract for the management of choledocholithiasis in this patient with a history of a Billroth II gastrectomy.

Keywords: Gastroenterostomy, Cholangiopancreatography, Endoscopic retrograde, Choledocholithiasis

Figures and Tables

Fig. 1

Abdominal CT scan. It demonstrates dilated intrahepatic bile duct and a 17×13 mm sized CBD stone in the distal CBD.

Fig. 2

Fistulotomy in a Billroth II patient. (A) The duodenal base of the papilla was pushed with the 11-o'clock margin of the cap, the papilla was turned to face the endoscope. After needle puncture of the bile duct, a soft-tipped 0.025 inch guidewire was advanced to gain access to the CBD after the fistulotomy. (B) After deep cannulation with the guidewire was achieved, cholangiogram was attained. Cholangiogram showed a 17×13 mm sized filling defect in the dilated CBD. (C) Two plastic stents were deployed into the CBD.

Fig. 3

Endoscopic view of papillary balloon dilatation through the fistulotomy tract (A) and a biliary stone extracted by using a Dormia basket without mechanical lithotripsy (B).

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