[Balloon-assisted sphincterotomy in patients with Billroth II gastrectomy and common bile duct stone: a new method]

diagnostic and therapeutic ERCP in patients with Billroth II gastrectomy is a challenging procedure due to anatomic alterations. New accessories and techniques were developed in order to minimize these adversities.

a new technique for biliary access in patients with Billroth II gastrectomy.

In the period from February 2003 to August 2007, 257 ERCP presented Billroth II gastrectomy and choledocolithiasis. In 37 of these patients catheterization by conventional technique was not possible and they were submitted to the new technique.

after fistulotomy in order to access CBD, a 0.035-inch guidewire was passed followed by an 8-mm dilator biliary balloon which was settled in transpapillary position. Through the working channel the knedle-knife was passed which when positioned in front of the papilla allowed the section of the sphincter over the balloon inflated with contrast until waist disappearance on radioscopy.

of the 37 patients submitted to the new procedure six were excluded. Sixteen patients (61.6%) were female and fifteen (48.4%) male. Age ranged from 29 to 89 years with a mean of 62.3 years. All patients had jaundice by clinical and laboratory tests. Time of procedure varied from 18 to 48 minutes (30 minutes). Diameter of the bile duct was 4.5 to 12.8 mm (7.7 mm) presenting one to seven calculi. There were occurred six (19.3%) complications related to the procedure, three (9.7%) pancreatitis, two (6.4%) hemorrhages and one (3.2%) perforation. There were no procedure-related deaths.

success of this technique was 83.8% (31 of the 37 cases); therefore the technique is considered a safe and efficient method in patients with Billroth II and difficult duodenal papilla cannulation and it was previously attempted by means of conventional cannulation technique.