Endoscopic management of common bile duct stones using double balloon endoscopy in postoperative patients: evaluation...

Endoscopic treatment of common bile duct (CBD) stones in patients with surgically altered anatomy is challenging because access to the duodenal papilla is often difficult. Although double balloon endoscopy-assisted ERCP (DB-ERCP) has become widespread, data on outcomes by reconstruction type remain limited.

A total of 218 patients treated between November 2016 and October 2024 were retrospectively reviewed. Among these, 212 patients were included: 159 with Roux-en-Y reconstruction (R group) and 53 with Billroth II reconstruction (B group). The primary endpoints were single-session complete stone clearance and procedure time.

The single-session complete stone clearance rate was 94.8%, with no significant difference between groups. Procedure time was significantly longer in the R group than in the B group (66.0 vs. 50.0 min, p < 0.001). Multivariate analysis identified R group (p < 0.001), age ≥75 years (p = 0.007), and ≥5 stones (p = 0.018) as independent factors for prolonged procedure time. In addition, ≥5 stones independently reduced single-session complete stone clearance (p < 0.001). Adverse events occurred in 2.8%, including one perforation, four bleeding events, and one pancreatitis case. Only one patient required surgery.

DB-ERCP achieved a high single-session complete stone clearance rate in patients with surgically altered anatomy, with outcomes comparable to those of conventional ERCP in patients with normal anatomy. These findings suggest that DB-ERCP may represent a first-line treatment option for CBD stones in surgically altered anatomy.