Efficacy of limited endoscopic sphincterotomy with endoscopic papillary large balloon dilatation in Billroth II gastrectomy patients with bile duct stones

Yıl 2011, Cilt: 19 Sayı: 3, 84 - 87, 01.12.2011

Selçuk Dişibeyaz Erkan Parlak Bülent Ödemiş Diğdem Özer Etik Olga Metin Semih Sezer Nurgül Şaşmaz Burhan Şahin

https://doi.org/10.17940/endoskopi.74848

Öz

Background/aims: Patients with Billroth II gastrectomy, who have modified anatomy of the gastrointestinal tract, present technical difficulties during endoscopic stone removal. Recently, a large balloon dilatation has been used especially for extraction of difficult bile duct stones after endoscopic sphincterotomy. The aim of this study was to evaluate the efficacy and safety of endoscopic papillary large balloon dilatation with limited endoscopic sphincterotomy for removal of bile duct stones in patients with Billroth II gastrectomy. Methods: Twelve patients (12 men; median age: 69 years) with bile duct stones and a history of Billroth II gastrectomy were enrolled. After cannulation, limited endoscopic sphincterotomy was performed. Then, a large balloon dilatation (balloon size, 12-18 mm) was performed and stones were removed conventionally or via mechanical lithotripsy. Successful stone removal and complications were evaluated. Results: In all cases, stones were removed successfully. The median number of sessions for complete stone removal was one (range 1-3). Stone removal by mechanical lithotripsy was achieved in three patients (11.5%). There were no significant complications such as bleeding, pancreatitis or perforation. Conclusions: Endoscopic papillary large balloon dilatation after endoscopic sphincterotomy appears to be an effective and safe method for removal of difficult bile duct stones in patients with Billroth II.

Anahtar Kelimeler

Billroth II gastrectomy, large balloon dilatation

Billroth II gastrektomili hastalarda koledok taşlarının temizlenmesi için kısmi biliyer sfinkterotomi ile birlikte "large" balon dilatasyonun etkinliği

Öz

Amaç: Billroth-II gastrektomi ameliyatı geçirmiş olan hastalarda değişen anatomik özellikler nedeniyle safra yolu taşlarının çıkartılması güçlük arz eder. Son yıllarda özellikle zor safra taşlarının çıkartılmasında endoskopik sfinkterotomiden sonra endoskopik papiller ''large'' ballon dilatasyonu uygulanmaktadı r. Bu çalışmanın amacı Billroth-II ameliyatı geçirmiş olan hastalarda endoskopik sfinkterotomi sonrası endoskopik papiller ''large'' ballon dilatasyonunun safra yolu taşı temizlenmesinde etkinliğinin ve güvenirliğinin araştı rılmasıdır. Gereç ve Yöntem: Billroth-II ameliyatı geçirmiş, safra yolu taşı olan ve konvansiyonel endoskopik sfinkterotomi ile taşı çıkartılamayacağı düşünülen hastalarda endoskopik sfinkterotomiyi takiben, koledok çapına eşit, 12-18 mm 'large'' ballon dilatasyonu uygulandı. Taşlar balon, basket veya mekanik litotripsi ile çıkartıldı. Bu yöntemin başarı ve komplikasyon oranları incelendi. Bulgular: On iki [hepsi erkek, ortalama yaş 69.0 (aralık 48-84) yıl)] Billroth-II ameliyatı geçirmiş olan hastaya kısmi endoskopik sfinkterotomiyi takiben 'large'' ballon dilatasyonu ile taş çıkarma girişiminde bulunuldu. 6 hastaya 12 mm, 6 hastaya 15 mm, 1 hastaya 18 mm balon uygulandı. Taş boyutu (enine çapı) ortalama 14,6 (aralık 12-18) mm idi. Koledok çapı ortalama 15,8 (aralık 10- 21) mm idi. On bir hastanın taşları 1 seansta, 1 hastanın taşları 2 seansta çıkartıldı. 1 hastaya mekanik litotripsi, 1 hastaya ESWL yardımı gerekti. İşlemden sonra 1 hastada az miktarda paraduodenal sıvı birikimi oldu. Bu hasta konvansiyonel tedbirlerle 3 gün içerisinde iyileşti. Kanama, pankreatit veya açık perforasyon hiçbir hastada gelişmedi. Sonuç: Endoskopik sfinkterotomi sonrası 'large'' ballon dilatasyonu, Billroth-II ameliyatı geçirmiş olan hastalarda zor safra yolu taşlarının çıkartılması nda etkili ve güvenli görülmektedir.

Anahtar Kelimeler

Billroth II gastrektomi, large, balon dilatasyon

Kaynakça

• Ersöz G, Tekeşin O, Özütemiz AO, Günşar, F. Biliary sphincterotomy plus dilation with a large balloon for bile duct stones that are difficult to extract. Gastrointest Endosc 2003;57:156-9.
• Heo JH, Kang DH, Jung HJ, et al. Endoscopic sphincterotomy plus lar- ge-balloon dilation versus endoscopic sphincterotomy for removal of bi- le-duct stones. Gastrointest Endosc 2007;66:720-6.
• Itoi T, Itokawa F, Sofuni A, et al. Endoscopic sphincterotomy combined with large balloon dilation can reduce the procedure time and fluoros- copy time for removal of large bile duct stones. Am J Gastroenterol 2009;104:560-5.
• Cotton PB, Lehman G, Vennes J, et al. Endoscopic sphincterotomy complications and their management: an attempt at consensus. Gastro- intest Endosc 1991;37:383-93.
• Forbes A, Cotton PB. ERCP and sphincterotomy after Billroth II gastrec- tomy. Gut 1984;25:971-4
• Hintze RE, Adler A, Veltzke W, Abou-Rebyeh H. Endoscopic access to the papilla of Vater for endoscopic retrograde cholangiopancreatography in patients with Billroth II or Roux-en-Y gastrojejunostomy. Endoscopy 1997;29:69-73
• Safrany L, Neuhaus B, Portocarrero G, Krause S. Endoscopic sphinctero- tomy in patients with Billroth II gastrectomy. Endoscopy 1980;12:16- 22.
• Rosseland AR, Osnes M, Kruse A. Endoscopic sphincterotomy (EST) in patients with Billroth II gastrectomy. Endoscopy 1981;13:19-24.
• Hintze RE, Veltzke W, Adler A, Abou-Rebyeh H. Endoscopic sphincte- rotomy using an S-shaped shincterotome in patient with a Billroth II or Roux-en-Y gastrojejunostomy. Endoscopy 1997; 29:74-8.
• Bergman JJ, van Berkel AM, Bruno MJ, et al. A randomized trial of en- doscopic balloon dilation and endoscopic sphincterotomy for removal of bile duct stones in patients with a prior Billroth II gastrectomy. Gastro- intest Endosc 2001;53:19-26.
• Wang YG, Binmoeller KF, Seifert H, et al. A new guide wire papillotome for patients with Billroth II gastrectomy. Endoscopy 1996; 28:254-5.
• Al-Kawas FH, Geller AJ. A new approach to sphincterotomy in patients with Billroth II gastrectomy. Gastrointest Endosc 1996;43:253-5.
• Faylona JM, Qadir A, Chan AC, et al. Small-bowel perforations related to endoscopic retrograde cholangiopancreatography (ERCP) in patients with Billroth II gastectomy. Endoscopy 1999;31:546-9.
• Kim MH, Lee SK, Lee MH, et al. Endoscopic retrograde cholangiopan- creatography and needle-knife sphincterotomy in patients with Billroth II gastrectomy: a comparative study of the forward-viewing endoscope and the side-viewing duodenoscope. Endoscopy 1997;29:82-5.
• Prat F, Fritsch J, Choury AD, et al. Endoscopic sphincteroplasty: a use- ful therapeutic tool for biliary endoscopy in Billroth II gastrectomy pati- ents. Endoscopy 1997;29:79-81.
• Bergman JJ, Rauws EA, Fockens P, et al. Randomized trial of endoscopic balloon dilatation versus endoscopic sphincterotomy for removal of bile duct stones. Lancet 1997;349:1124-9.
• Disario JA, Freeman ML, Bjorkman DJ, et al. Endoscopic balloon dilata- tion compared with sphincterotomy for extraction of bile duct stones. Gastroenterology 2004;127:1291-9.
• Yoo BM, Kim JH, Jung JH, et al. Large balloon sphincteroplasty along with or without sphincterotomy in patients with large extrahepatic bile duct stones: multi center study. Gastrointest Endosc 2007;65:AB97.
• Maydeo A, Bhandari S. Balloon sphincteroplasty for removing difficult bile duct stones. Endoscopy 2007;39:958-61.
• Nakahara K, Horaguchi J, Fujita N, et al. Therapeutic endoscopic retrog- rade cholangiopancreatography using an anterior oblique-viewing en- doscope for bile duct stones in patients with prior Billroth II gastrec- tomy. J Gastroenterol 2009;44:212-7.
• van Buuren HR, Boender J, Nix GA, van Blankenstein M. Needle-knife sphincterotomy guided by a biliary endoprosthesis in Billroth II gastrec- tomy patients. Endoscopy 1995;27:229-32.
• Itoi T, Ishii K, Itokawa F, et al. Large balloon papillary dilation for remo- val of bile duct stones in patients who have undergone a Billroth II gas- trectomy. Dig Endosc. 2010;22:S98-102.
• Kim GH, Kang DH, Song GA, et al. Endoscopic removal of bile-duct sto- nes by using a rotatable papillotome and a large-balloon dilator in pati- ents with a Billroth II gastrectomy. Gastrointest Endosc 2008;67:1134-8.
• Choi CW, Choi JS, Kang DH, et al. Endoscopic papillary large balloon dilation in Billroth II gastrectomy patients with bile duct stones. J Gas- troenterol Hepatol 2011 Jul 28. doi: 10.1111/j.1440-1746.2011.06863.
• Park SY, Park CH, Yoon KW, et al. Endoscopic large-diameter balloon dilation after fistulotomy for the removal of bile duct stones in a difficult cannulation. Gastrointest Endosc. 2009;69:955-9.
• Attasaranya S, Cheon YK, Vittal H, et al. Large-diameter biliary orifice balloon dilation to aid in endoscopic bile duct stone removal: a multi- center series. Gastrointest Endosc. 2008;67:1046-52.