Chonnam Med J.  2010 Apr;46(1):62-66. 10.4068/cmj.2010.46.1.62.

Endoscopic Large-Diameter Balloon Dilation after Fistulotomy for the Removal of Bile Duct Stones in a Patient with Billroth II Gastrectomy

  • 1Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea.


Endoscopic retrograde cholangiopancreatography (ERCP) is difficult to perform in patients with a Billroth II gastrectomy because of anatomical changes. The success rate of ERCP and endoscopic sphincterotomy in patients with a Billroth II gastrectomy is lower than that in patients with normal anatomy. In our case, a 76-year-old man with altered anatomy after a Billroth II gastrectomy underwent cap-assisted forward-viewing endoscopic cholangiopancreatography because of bile duct stones. We successfully performed a fistulotomy followed by large-diameter balloon dilation of the fistulotomy tract for the management of choledocholithiasis in this patient with a history of a Billroth II gastrectomy.


Gastroenterostomy; Cholangiopancreatography, Endoscopic retrograde; Choledocholithiasis

MeSH Terms

Bile Ducts
Cholangiopancreatography, Endoscopic Retrograde
Sphincterotomy, Endoscopic


  • Fig. 1 Abdominal CT scan. It demonstrates dilated intrahepatic bile duct and a 17×13 mm sized CBD stone in the distal CBD.

  • Fig. 2 Fistulotomy in a Billroth II patient. (A) The duodenal base of the papilla was pushed with the 11-o'clock margin of the cap, the papilla was turned to face the endoscope. After needle puncture of the bile duct, a soft-tipped 0.025 inch guidewire was advanced to gain access to the CBD after the fistulotomy. (B) After deep cannulation with the guidewire was achieved, cholangiogram was attained. Cholangiogram showed a 17×13 mm sized filling defect in the dilated CBD. (C) Two plastic stents were deployed into the CBD.

  • Fig. 3 Endoscopic view of papillary balloon dilatation through the fistulotomy tract (A) and a biliary stone extracted by using a Dormia basket without mechanical lithotripsy (B).


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