Abstract
Fourteen patients over 75 years of age, who had undergone gastrectomy with reconstruction by Billroth II (B-II) or Roux-en-Y (RY), were enrolled in a study for transpapillary treatment of bile duct stones, spanning 13 years from April 1996; in this study, an oblique-viewing endoscope was used for treatment. The B-II group included 10 patients (5 males and 5 females), and the RY group included 4 male patients; the mean age of the patients in both the groups was 81 years. In the B-II patients, the major papilla could be located sooner, and the success ratio was higher than that in the RY patients (time, 8 vs. 23 minutes; success ratio, 100 vs. 75%). The mean completion time was shorter, and the completion ratio of the endoscopic procedure was higher in the B-II group than in the RY group (mean time, 28 vs. 49 minutes; completion ratio, 90 vs. 75%). In 2 patients, endoscopic retrograde cholangiopancreatography (ERCP) failed because of the presence of a large stone in the juxtapapillary diverticulum or an inaccessible major papilla. No major complications were observed in both the groups. These results suggest that B-II patients may be indicated for transpapillary treatment of bile duct stones with an oblique-viewing endoscope. However, additional studies are required before this treatment can be recommended for RY patients.
