Peroral direct cholangioscopy for common bile duct stones after Billroth II gastrectomy: Report of a case

Abstract

An 88-year-old man with prior Billroth II gastrectomy was admitted to our hospital because of choledocholithiasis. We conducted ERCP successfully using PCF260AI. The common bile duct was dilated and several common bile duct stones about 20mm in diameter were observed. Endoscopic sphincterotomy was performed, but we could not crush the stones by mechanical lithotripsy. We decided to try electrohydraulic lithotripsy (EHL) by peroral direct cholangioscopy (PDCS) using an ultra-slim endoscope. The scope was advanced into the common bile duct over a 5 Fr. nasobiliary drainage tube. EHL and stone extraction with a basket could be accomplished easily and safely by direct visualization of a clear image. There was no complication. EHL of the common bile duct stone under PDCS by using an ultra-slim endoscope was useful in a patient who could not be treated by conventional methods with a Billroth II gastrectomy.