Department of Internal Medicine, Pusan National University School of Medicine, Yangsan, Korea.
J Gastroenterol Hepatol. 2012 Feb;27(2):256-60. doi: 10.1111/j.1440-1746.2011.06863.x.
Patients with Billroth II (B-II) gastrectomy present technical difficulties during endoscopic stone removal due to altered anatomy. Although endoscopic sphincterotomy alone or endoscopic balloon dilation alone has been used for removal of bile duct stones in patients with B-II gastrectomy, the results are not satisfactory. The aim of this study was to evaluate the efficacy and safety of endoscopic papillary large balloon dilation (EPLBD) for removal of bile duct stones in patients with B-II gastrectomy.
Twenty-six patients (20 men and six women; median age 72 years) with bile duct stones and a history of B-II gastrectomy were enrolled. After cannulation, limited endoscopic sphincterotomy was performed. Then, balloon dilation (balloon size, 10-15 mm) was performed and stones were removed conventionally or via mechanical lithotripsy. Successful stone removal and complications were evaluated.
In all cases, stones were successfully removed. 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.
Endoscopic papillary large balloon dilation is an effective and safe method for removal of bile duct stones. We suggest consideration of this technique for removal of bile duct stones in patients with B-II gastrectomy.
由于解剖结构改变，行毕Ⅱ式胃大部切除术后的患者在行内镜下取石时存在技术困难。虽然单独行内镜下括约肌切开术或内镜下球囊扩张术已用于治疗毕Ⅱ式胃大部切除术后患者的胆管结石，但效果并不满意。本研究旨在评估内镜乳头大球囊扩张术（EPLBD）用于治疗毕Ⅱ式胃大部切除术后患者胆管结石的疗效和安全性。
26 例（男 20 例，女 6 例；中位年龄 72 岁）有胆管结石且行毕Ⅱ式胃大部切除术病史的患者被纳入研究。在插管后，行有限的内镜下括约肌切开术。然后行球囊扩张（球囊大小 10-15mm），常规或通过机械碎石术取石。评估取石的成功率和并发症。
所有患者均成功取出结石。完全取石所需的平均操作次数为 1 次（范围 1-3 次）。3 例患者（11.5%）通过机械碎石术成功取石。无明显并发症，如出血、胰腺炎或穿孔。
内镜乳头大球囊扩张术是一种有效且安全的胆管取石方法。我们建议对于毕Ⅱ式胃大部切除术后患者的胆管结石，可考虑使用这种技术取石。
