Department of Gastroenterology, Changhai Hospital, Second Military Medical University, 168 Changhai Road, Shanghai, 200433, China.
Digestive Endoscopy Center, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Middle Yanchang Road No. 301, Shanghai, 200072, China.
Surg Endosc. 2020 Jun;34(6):2454-2459. doi: 10.1007/s00464-019-07039-8. Epub 2019 Aug 2.
Endoscopic retrograde cholangiopancreatography (ERCP) for extraction of common bile duct (CBD) stones in Billroth II anatomy patients is still a technical challenge and factors affecting stone extraction have not yet been clarified. This study aimed to analyze our experience and evaluate potential factors affecting CBD stone extraction.
A retrospective analysis of CBD stones patients with a history of Billroth II gastrectomy, who underwent therapeutic ERCP for stone extraction at our center from August 1999 to December 2017, was conducted. The outcomes of ERCP and potential factors affecting stone extraction were examined.
A total of 227 patients were enrolled, and 176 patients (77.5%) achieved technical success. The success rate of duodenal ampullary access and selective biliary cannulation was 84.1% (191/227) and 92.1% (176/191), respectively. The mean CBD diameter was 15 mm (range 6-35 mm), and the largest stone size was 13 mm (range 4-36 mm). CBD stones were ultimately removed in 137 patients (77.8%), and 105 patients (59.7%) for the first session. Mechanical lithotripsy was used in 17 patients (9.7%). The overall ERCP-related complication rate was 6.3% (11/176), including bleeding in 3 patients (1.7%) and mild pancreatitis in 6 patients (3.4%). The multivariate analysis indicated that CBD stone number ≥ 2 (OR 2.171; 95% CI 1.095-4.306; p = 0.027), and the largest CBD stone size ≥ 12 mm (OR 3.646; 95% CI 1.833-7.251; p < 0.001) were patient-related risk factors for failed stone removal; while the use of endoscopic papillary (large) balloon dilation (EPBD/EPLBD) (OR 0.291; 95% CI 0.147-0.576; p < 0.001) was a procedure-related protective factor for successful stone extraction.
ERCP is safe and effective for extraction of CBD stones in Billroth II anatomy patients. The number and the largest size of CBD stones, and the use of EPBD/EPLBD are predictive factors for CBD stone extraction.
在毕罗氏 II 型胃大部切除术后的患者中，通过内镜逆行胰胆管造影术（ERCP）取胆总管（CBD）结石仍然是一项技术挑战，影响取石的因素尚未明确。本研究旨在分析我们的经验并评估影响 CBD 结石取石的潜在因素。
对 1999 年 8 月至 2017 年 12 月在我院行 ERCP 取石治疗的毕罗氏 II 型胃大部切除术后 CBD 结石患者进行回顾性分析。检查了 ERCP 的结果和影响结石取石的潜在因素。
共纳入 227 例患者，其中 176 例（77.5%）患者达到技术成功。十二指肠乳头入路和选择性胆管插管的成功率分别为 84.1%（191/227）和 92.1%（176/191）。CBD 直径平均为 15mm（范围 6-35mm），最大结石大小为 13mm（范围 4-36mm）。最终 137 例（77.8%）患者的 CBD 结石被清除，其中 105 例（59.7%）为首次取石。17 例（9.7%）患者采用机械碎石。总的 ERCP 相关并发症发生率为 6.3%（11/176），包括 3 例（1.7%）出血和 6 例（3.4%）轻度胰腺炎。多因素分析表明，CBD 结石数量≥2 个（OR 2.171；95%CI 1.095-4.306；p=0.027）和最大 CBD 结石直径≥12mm（OR 3.646；95%CI 1.833-7.251；p<0.001）是患者相关的结石取石失败的危险因素；而使用内镜乳头（大）球囊扩张术（EPBD/EPLBD）（OR 0.291；95%CI 0.147-0.576；p<0.001）是 CBD 结石取石成功的手术相关保护因素。
ERCP 是毕罗氏 II 型解剖患者取 CBD 结石安全有效的方法。CBD 结石数量、最大直径以及 EPBD/EPLBD 的使用是影响 CBD 结石取石的预测因素。
