Open AccessEndoscopic ultrasound for choledocholithiasis in Billroth II altered anatomy
Author(s) -
Tatiana Silina,
Yu. B. Busyrev,
A. B. Shalygin,
A. S. Vorotyntsev,
A. Yu. Emelyanov,
A. A. Gvozdev,
К. Н. Журавлев,
Natalia A. Rucheva,
A. V. Kameneva
Publication year - 2020
Publication title -
èksperimentalʹnaâ i kliničeskaâ gastroènterologiâ
Language(s) - English
Resource type - Journals
ISSN - 1682-8658
DOI - 10.31146/1682-8658-ecg-184-12-128-131
Subject(s) - medicine , major duodenal papilla , billroth ii , common bile duct , gallstones , surgery , endoscopic ultrasound , bile duct , ultrasound , billroth i , radiology , general surgery , gastrectomy , cancer
Background and Objectives : Increasing application of EUSguided biliary drainage, however, does not determine the capabilities of complete EUSinvestigation of the common bile duct in patients with surgically altered upper gastrointestinal anatomy. The purpose of this study is to evaluate the specifi city and eff ectiveness of EUS for choledocholithiasis in a patient with Billroth II altered anatomy. Patient and Methods : A 61-year-old female patient underwent a Billroth II gastric resection about 25 years ago. Choledocholithiasis was diagnosed a year ago. At the present examination, the results of ultrasound and MRCP were doubtful. Gastroscopy showed the ability to intubate the afferent limb with accessible papilla. EUS was performed to decide on further patient management. Results : The common bile duct EUS-visualization was performed both from the gastric stump and from the afferent limb. The differences of intubating the afferent limb in comparison with the EGD, as well as the differences of the ultrasound picture in comparison with the traditional EUS of CBD were determined. Two CBD stones were detected by scanning from the afferent limb. ERCP was done in the same sedation session with balloon papilla dilatation and both stones lithoextraction. Laparoscopic cholecystectomy was performed on the second day without complications. The patient was discharged from the hospital on the fifth day after surgery. Within 10 months she feels well, no complaints. Conclusions : EUS can be diagnostic method of choice for choledocholithiasis in patients with Billroth II altered anatomy if intubation of the afferent limb was confirmed endoscopically.