Selçuk DİŞİBEYAZ, Erkan PARLAK, Bülent ÖDEMİŞ, Diğdem Özer ETİK, Olga METİN, Semih SEZER, Nurgül ŞAŞMAZ, Burhan ŞAHİN

Billroth II gastrektomili hastalarda koledok taşlarının temizlenmesi için kısmi biliyer sfinkterotomi ile birlikte "large" balon dilatasyonun etkinliği

Amaç: Billroth-II gastrektomi ameliyatı geçirmiş olan hastalarda değişen anatomik özellikler nedeniyle safra yolu taşlarının çıkartılması güçlük arz eder. Son yıllarda özellikle zor safra taşlarının çıkartılmasında endoskopik sfinkterotomiden sonra endoskopik papiller ''large'' ballon dilatasyonu uygulanmaktadı r. Bu çalışmanın amacı Billroth-II ameliyatı geçirmiş olan hastalarda endoskopik sfinkterotomi sonrası endoskopik papiller ''large'' ballon dilatasyonunun safra yolu taşı temizlenmesinde etkinliğinin ve güvenirliğinin araştı rılmasıdır. Gereç ve Yöntem: Billroth-II ameliyatı geçirmiş, safra yolu taşı olan ve konvansiyonel endoskopik sfinkterotomi ile taşı çıkartılamayacağı düşünülen hastalarda endoskopik sfinkterotomiyi takiben, koledok çapına eşit, 12-18 mm 'large'' ballon dilatasyonu uygulandı. Taşlar balon, basket veya mekanik litotripsi ile çıkartıldı. Bu yöntemin başarı ve komplikasyon oranları incelendi. Bulgular: On iki [hepsi erkek, ortalama yaş 69.0 (aralık 48-84) yıl)] Billroth-II ameliyatı geçirmiş olan hastaya kısmi endoskopik sfinkterotomiyi takiben 'large'' ballon dilatasyonu ile taş çıkarma girişiminde bulunuldu. 6 hastaya 12 mm, 6 hastaya 15 mm, 1 hastaya 18 mm balon uygulandı. Taş boyutu (enine çapı) ortalama 14,6 (aralık 12-18) mm idi. Koledok çapı ortalama 15,8 (aralık 10- 21) mm idi. On bir hastanın taşları 1 seansta, 1 hastanın taşları 2 seansta çıkartıldı. 1 hastaya mekanik litotripsi, 1 hastaya ESWL yardımı gerekti. İşlemden sonra 1 hastada az miktarda paraduodenal sıvı birikimi oldu. Bu hasta konvansiyonel tedbirlerle 3 gün içerisinde iyileşti. Kanama, pankreatit veya açık perforasyon hiçbir hastada gelişmedi. Sonuç: Endoskopik sfinkterotomi sonrası 'large'' ballon dilatasyonu, Billroth-II ameliyatı geçirmiş olan hastalarda zor safra yolu taşlarının çıkartılması nda etkili ve güvenli görülmektedir.

Anahtar Kelimeler:

Billroth II gastrektomi, large, balon dilatasyon

Efficacy of limited endoscopic sphincterotomy with endoscopic papillary large balloon dilatation in Billroth II gastrectomy patients with bile duct stones

Background/aims: Patients with Billroth II gastrectomy, who have modified anatomy of the gastrointestinal tract, present technical difficulties during endoscopic stone removal. Recently, a large balloon dilatation has been used especially for extraction of difficult bile duct stones after endoscopic sphincterotomy. The aim of this study was to evaluate the efficacy and safety of endoscopic papillary large balloon dilatation with limited endoscopic sphincterotomy for removal of bile duct stones in patients with Billroth II gastrectomy. Methods: Twelve patients (12 men; median age: 69 years) with bile duct stones and a history of Billroth II gastrectomy were enrolled. After cannulation, limited endoscopic sphincterotomy was performed. Then, a large balloon dilatation (balloon size, 12-18 mm) was performed and stones were removed conventionally or via mechanical lithotripsy. Successful stone removal and complications were evaluated. Results: In all cases, stones were removed successfully. The median number of sessions for complete stone removal was one (range 1-3). Stone removal by mechanical lithotripsy was achieved in three patients (11.5%). There were no significant complications such as bleeding, pancreatitis or perforation. Conclusions: Endoscopic papillary large balloon dilatation after endoscopic sphincterotomy appears to be an effective and safe method for removal of difficult bile duct stones in patients with Billroth II.

Keywords:

Billroth II gastrectomy, large balloon dilatation,

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