New endoscopic approachsuccessfully extracted comm
Bile stone extraction through duodenal endoscopy for patients after Billroth's II subtotal gastrectomy and gastro-jejunum anastomosis with changes of the anatomy of the gastro-intestinal tract is a difficult issue in medicine. Professor Chen Jinjun of the department of hepatobiliary surgery adopted a new approach for endoscopic bile stone extraction had already succeeded in the extraction of common bile duct stone in 8 cases following Billroth's II gastro-jejunostomy. Dr. Chen et al approached from the esophagus, gastric lumen and then inserted the endoscope through the jejunum input loop, acrossing the ligament of Treiz to get access into the descending portion of the duodenum with an inversed direction. When the Vater's ampulla was visualized with its orifice facing downwards, the stone in the common bile duct could be seen by inserting the endoscope in a right and downward direction; the ampulla was then incised at the point of 5-6 oclock for a length necessary for stone extraction. The basket for stone extraction was then inserted into the common bile duct and the stone was then successfully extracted leaving no side effect to the patients.
As was recommended by Professor Chen Jinjun, head of the department, there are two key points of success of this three linkage stone extraction technique: Firstly, the duodenum endoscope must be successfully inserted into the inlet loop of the jejunum; secondly, insertion of the endoscope, contrast medium examination and the incision of the ampulla should be done at the point in 5-6 oclock at the right inferior aspect of the inversely situated Vater's
ampulla.