Abstract
The case described a 75-year-old man who has been treated because of liver cirrhosis due to hepatitis C. In May 2000, a common bile duct (CBD) stone, measuring 8 mm in diameter, was detected at abdominal CT scanning. Because he had undergone Billroth II gastrectomy, it was difficult to access to a papilla and insert a catheter into the bile duct using a side-viewing scope or a direct-viewing scope. An anterior oblique-viewing make access of Vater's papilla and control of a catheter easy, but the cannulation was failed. Thus percutaneous transhepatic cholangiodrainage was performed and an anterior oblique-viewing endoscope was inserted. After that, a guidewire was introduced from drainage tube into the scope ; The wire was grasped by a forceps and was passed through the forceps channel ; endoscopic papillary balloon dilation (EPBD) was then performed using a balloon catheter for dilation (MaxForce ; maximum dilated diameter 8 mm ; length 3 cm) , leading to successful removal of stones. Our experience in this case indicated that EPBD with an anterior oblique-viewing endoscope is useful for the treatment of CBD stones following Billroth II gastrectomy, and that EPBD can be applied with the percutaneous transhepatic assistance, even to the cases with difficulty in transpapillary approach, demonstrating the potent application of EPBD to a wider range of cases.
