Endoscopic management of common bile duct stones using double balloon endoscopy in postoperative patients: evaluation of single-session complete stone clearance

Background Endoscopic treatment of common bile duct (CBD) stones in patients with surgically altered anatomy is challenging because access to the duodenal papilla is often difficult. Although double balloon endoscopy-assisted ERCP (DB-ERCP) has become widespread, data on outcomes by reconstruction type remain limited.Methods A total of 218 patients treated between November 2016 and October 2024 were retrospectively reviewed. Among these, 212 patients were included: 159 with Roux-en-Y reconstruction (R group) and 53 with Billroth II reconstruction (B group). The primary endpoints were single-session complete stone clearance and procedure time.Results The single-session complete stone clearance rate was 94.8%, with no significant difference between groups. Procedure time was significantly longer in the R group than in the B group (66.0 vs. 50.0 min, p < 0.001). Multivariate analysis identified R group (p < 0.001), age ≥75 years (p = 0.007), and ≥5 stones (p = 0.018) as independent factors for prolonged procedure time. In addition, ≥5 stones independently reduced single-session complete stone clearance (p < 0.001). Adverse events occurred in 2.8%, including one perforation, four bleeding events, and one pancreatitis case. Only one patient required surgery.Conclusion DB-ERCP achieved a high single-session complete stone clearance rate in patients with surgically altered anatomy, with outcomes comparable to those of conventional ERCP in patients with normal anatomy. These findings suggest that DB-ERCP may represent a first-line treatment option for CBD stones in surgically altered anatomy.