Balloon Enteroscopy-assisted Endoscopic Retrograde Cholangiopancreatography for Choledocholithiasis in Situs Inversus Totalis With Billroth II Reconstruction: A Case Report and Literature Review.
ERCP can be successfully performed in patients with situs inversus totalis and Billroth II reconstruction, achieving complete stone clearance without adverse events.
Where it sits
this study against the rest of the aod-9604 corpusSummary and findings
A 56-year-old man with situs inversus totalis and Billroth II reconstruction underwent endoscopic retrograde cholangiopancreatography (ERCP) for common bile duct stones. ERCP was performed successfully without adverse events, achieving complete stone clearance. No specific dose information was reported.
Abstract
Endoscopic retrograde cholangiopancreatography (ERCP) in patients with situs inversus totalis (SIT) and Billroth II reconstruction is technically challenging because of mirror-image anatomy, altered access to the papilla, and inverted papillary orientation. A 56-year-old man with a history of distal gastrectomy with Billroth II reconstruction for a gastric ulcer 20 years earlier was found to have common bile duct stones on pre-ERCP imaging. ERCP was performed in the prone position, as in conventional ERCP, with the endoscopist standing on the patient's right side. A short-type single-balloon enteroscope was advanced through the afferent limb to the major papilla. Biliary cannulation was achieved using a standard ERCP catheter without positional modification or sphincterotome. Cholangiography confirmed small common bile duct stones. Endoscopic papillary balloon dilation with an 8-mm balloon was performed, followed by stone extraction using a basket catheter. Final cholangiography confirmed complete stone clearance, and no adverse events, including post-ERCP pancreatitis, occurred. This case suggests that favorable alignment between the 7 o'clock working-channel direction and the bile duct axis may allow conventional-position ERCP in selected patients with SIT and Billroth II reconstruction.
Background
This paper addresses the challenges of performing endoscopic retrograde cholangiopancreatography (ERCP) in patients with situs inversus totalis (SIT) and Billroth II reconstruction. Previous literature indicates that altered anatomy complicates access to the bile duct, making ERCP technically difficult. This study is significant as it explores the feasibility of conventional ERCP techniques in a patient with such complex anatomy.
Methods
The study describes a case report involving a 56-year-old male patient with a history of distal gastrectomy and Billroth II reconstruction. The ERCP was performed in the prone position, with the endoscopist positioned on the patient's right side. Specific details regarding the duration, primary outcome measures, and sample size are not provided.
Results
Cholangiography confirmed the presence of small common bile duct stones. Endoscopic papillary balloon dilation was performed using an 8-mm balloon, followed by stone extraction with a basket catheter. Final cholangiography confirmed complete stone clearance.
Interpretation
The findings suggest that conventional ERCP techniques may be applicable in selected patients with SIT and Billroth II reconstruction, which contrasts with previous assumptions about the limitations of such procedures in complex anatomical situations. However, the lack of a control group and the single-case nature of the report limit the generalizability of the results. The absence of adverse events is noteworthy but does not imply that the procedure is universally safe for all patients with similar conditions.
Key findings
- Complete stone clearance confirmed by final cholangiography.
- No adverse events, including post-ERCP pancreatitis, occurred.
Limitations
- Single case report limits generalizability.
- No control group for comparison.
- Not reported in abstract.