Abstract
The patient was an 86-year-old woman who underwent total gastrectomy (Roux-Y reconstruction) . Her previous physician had diagnosed cholangitis caused by common-bile-duct stones. Percutaneous transhepatic biliary drainage was performed, and the patient was transferred to our hospital. We inserted a short-type single balloon enteroscope (SBE) to the duodenal papilla. Cholangiography confirmed the presence of multiple bile-duct stones, with a maximal diameter of 21 mm. After endoscopic papillary large-balloon dilation was performed, lithotripsy was attempted, using a guidewire-type 4-wire basket and a balloon catheter. However, the procedure required a prolonged time and was discontinued without removing all stones. At a later date, direct cholangioscopy was performed using an SBE and confirmed the presence of residual stones. Direct cholangioscopy was then carried out, and the residual stones were directly grasped and crushed with a 5-prong forceps, resulting in complete cure. Direct cholangioscopy is a useful procedure for confirming and treating residual bile-duct stones, even in patients who have undergone gastric surgery with gastrointestinal reconstruction.
