Long-term Outcomes Of Endoscopic Papillary Balloon Dilation For Removal Of Bile Duct Stones In Billroth Ⅱ Gastrectomy Patients

Background and aims: Endoscopic papillary balloon dilation(EPBD)has been proven safe and effective for removal of bile duct stones in BillrothⅡ gastrectomy patients.However,few reports exist regarding the long-term outcomes of this technique.The purpose of this study was to assess longterm outcomes of EPBD for removal of bile duct stones in patients after BillrothⅡ gastrectomy.Methods: The records of patients with previous BillrothⅡ gastrectomy referred for bile duct stones removal with EPBD between July 2008 and September 2016 were retrospectively reviewed in our center.The primary outcomes of complete stone clearance,ERCP-related adverse events,late biliary complication during long-term follow-up were evaluated.Besides,the risk factors associated with stone recurrence were also analyzed.Results: A total of 49 consecutive patients with prior BillrothⅡ gastrectomy referred to EPBD for removal of bile duct stones undergoing 59 ERCP procedures were enrolled.The overall complete stone clearance was achieved in 42 patients(85.7%).Post-ERCP pancreatitis was in 3 ERCP procedures(5.1%).Severe complications,including perforation and bleeding,were not observed.After a median follow-up of 50.5 months(range 4-101 months)from complete stone removal,6 of 49 patients(12.2%)had stone recurrence after a median period of 22.5 months(range 6-71months).Female(odds ratio [OR],11.352;95% confidence interval CI,1.040-123.912;P=0.046)and previous mechanical lithotripsy([OR],13.423;95%CI,1.070-168.434;P=0.044)were significantly associated with stone recurrence.Conclusion: At long-term follow-up,EPBD for removal of CBD stones appeared to be safe and effective in BillrothⅡ gastrectomy patients.Female and previous mechanical lithotripsy were independent risk factors for symptomatic stone recurrence.