Restoration of common bile duct diameter within 2 weeks after endoscopic stone retraction is a preventive factor for stone recurrence

Background： Little information is available about the relationship between restoration of common bileduct （CBD） diameter after endoscopic stone retraction and recurrence of CBD stones in elderly patients.The present study was to determine whether restoration of CBD diameter is a preventive factor for CBDstone recurrence in elderly patients who underwent endoscopic retrograde cholangiopancreatography（ERCP）.

Self-expandable metal stents for choledocholithiasis in Billroth II gastrectomy patients

Background: Efficient ampullary intervention is essential for endoscopic retrograde cholangiopancreatography(ERCP) in patients with a prior Billroth II gastrectomy. We retrospectively evaluated the safety and effectiveness of ampullary intervention using fully covered self-expandable metal stents(FCSEMSs) for the management of common bile duct(CBD) stones in a subset of patients with a history of Billroth II gastrectomy. Methods: This retrospective analysis involved patients with a prior Billroth II gastrectomy who underwent ampullary intervention with FCSEMSs for the management of CBD stones. The factors associated with FCSEMSs placement, treatment success, and procedural complications were analyzed. Results: A group of 15 patients(10 males; median age, 78 years) underwent biliary metal stent placement for high degree of CBD angulation(6), small or flat papilla with unclear margin(5), current use of double antiplatelet agents or an anticoagulant(2), unwanted instrumentation of the cystic duct(1), and insecure position of the scope(1). Ampullary intervention with FCSEMSs was successful in all patients. After dilating the ampulla of Vater and building a durable conduit with FCSEMSs immediately, CBD stones were removed successfully from all patients in a single session. A mild post-ERCP pancreatitis occurred in one patient, who recovered without complications. Conclusion: Ampullary intervention with FCSEMSs is safe and effective for the management of CBD stones in a subset of patients with a history of Billroth II gastrectomy.