EXPANDABLE METALLIC STENT-ASSISTED BILIARY LITHOTRIPSY IN PATIENTS WITH BILLROTH II GASTRECTOMY

The difficulty in orienting a duodenoscope or sphincterotome in Billroth II gastrectomy patients with an afferent loop is well known to experienced biliary endoscopists. Endoscopic papillary balloon dilation (EPD) can be particularly useful in this group of patients. However, while EPD is relatively simple, lithotripsy afterward is difficult. To address this point, a new technique was developed to gain and preserve access to the common bile duct (CBD). This new technique, expandable metallic stent-assisted biliary lithotripsy (EMS-L), utilizes a self-expandable metallic stent to dilate the major duodenal papilla and preserve access to the CBD. In three patients who had previously undergone a Billroth II gastrectomy, EMS-L was attempted and was successful. No previous reports of EMS-L in Billroth II gastrectomy patients are available.