Endoscopic Papillary Large Balloon Dilatation Without Preceding Sphincterotomy For Removal Choledocholithiasis In Patients With ROUX-EN-Y Surgery

Aims We retrospectively evaluated the feasibility and safety of endoscopic papillary large balloon dilatation without preceding sphincterotomy for the removal of choledocholithiasis.

Methods Large balloon Papillary dilation for the removal of choledocholithiasis was performed on the intact papilla in 11 patients with Roux-en-Y surgery (8 men and 3 women, mean age 82 years, age range 60-91 years), between January 2018 and July 2020, at our institution. ERCP was performed with a 200-cm length and a 2.8 mm diameter working channel, Single Balloon Enteroscopy system (SIF Q180; Olympus Medical Systems, Tokyo, Japan), and ST-SB1 overtube. To facilitate the identification and cannulation of the papilla, a “rigid” transparent cap was attached to the tip of the enteroscope, in most procedures. All procedures were performed in the supine position. Cannulation, cholangiography, and sphincteroplasty were always attempted and carried out using a conventional esophageal/pyloric/colonic dilation balloon catheter (CRE Microvasive, Boston Scientific, Ireland). Balloon dilation sphincteroplasty was adapted to the duct diameter and stone size. The size of large balloon used ranged from 12 mm to 13.5 mm. The stones were then removed from the common bile duct with a basket or a retrieval balloon. All patients received NSAIDs after the procedure.

Results Complete clearance of choledocholithiasis was achieved in all cases. Only two patients underwent the procedure twice to achieve papilla cannulation. A mechanical lithotriptor was not required. Mild pancreatitis did occur in a patient.

Conclusions Large balloon papillary dilation without preceding sphincterotomy appears to be an effective and safe treatment for the removal of choledocholithiasis in patients with Roux-en-Y surgery.

Citation Espinel J, Pinedo E. eP320 ENDOSCOPIC PAPILLARY LARGE BALLOON DILATATION WITHOUT PRECEDING SPHINCTEROTOMY FOR REMOVAL CHOLEDOCHOLITHIASIS IN PATIENTS WITH ROUX-EN-Y SURGERY. Endoscopy 2021; 53: S202.

Publication History

Article published online:
19 March 2021