Small Endoscopic Sphincterotomy plus Large-Balloon Dilation for Removal of Large Common Bile Duct Stones during ERCP.

Objective: This study compared the therapeutic benefits and complication rates of small endoscopic sphincterotomy plus large-balloon dilation (ESLBD) with those of endoscopic sphincterotomy (EST) alone for large bile duct stones. Methods: We compared prospectively ESLBD group (n=63) with conventional EST group (n=69) for the treatment of large bile duct stones (≥15mm). Mechanical lithotripsy was performed when the stone could not be removed using a normal basket. We compared the rates of stone removal, frequency of mechanical lithotripsy use, procedure-related complications, and recurrent stones. Results: A total of 132 patients were reviewed in the study. The mean age of the patients was 67.9 years. The two groups showed significant differences in complete stone removal during the first session (80.9 vs. 60.8%; P = 0.046), the use of mechanical lithotripsy (7.94 vs. 24.6%; P = 0.041), and less duration of admission (P =0.045). After ERCP, there were some instances of oozing in both groups, All patients recovered completely, 14 patients had recurrent common bile duct stones among the follow-up duration. Conclusion: The ESLBD technique seems to be a feasible and safe alternative technique for conventional EST and EBD and has no more Post-ERCP complications.

[1]  Jun-bo Qian,et al.  Prevention of post‐endoscopic retrograde cholangiopancreatography pancreatitis by epinephrine sprayed on the papilla , 2011, Journal of gastroenterology and hepatology.

[2]  H. Pan,et al.  Endoscopic papillary large balloon dilation alone without sphincterotomy for the treatment of large common bile duct stones , 2011, BMC gastroenterology.

[3]  Tae Hyeon Kim,et al.  Can a small endoscopic sphincterotomy plus a large-balloon dilation reduce the use of mechanical lithotripsy in patients with large bile duct stones? , 2011, Surgical Endoscopy.

[4]  J. Moon,et al.  Small sphincterotomy combined with endoscopic papillary large balloon dilation versus sphincterotomy. , 2009, World journal of gastroenterology.

[5]  C. Forsmark,et al.  Large Size Balloon Dilation of the Ampulla After Biliary Sphincterotomy Can Facilitate Endoscopic Extraction of Difficult Bile Duct Stones , 2009, Journal of clinical gastroenterology.

[6]  M. Freeman,et al.  Endoscopic papillary large balloon dilation for large common bile duct stones. , 2009, Journal of hepato-biliary-pancreatic surgery.

[7]  S. Hirose,et al.  Small sphincterotomy combined with papillary dilation with large balloon permits retrieval of large stones without mechanical lithotripsy. , 2007, World journal of gastroenterology.

[8]  Seung Woo Park,et al.  Endoscopic Papillary Balloon Dilation with Large Balloon after Limited Sphincterotomy for Retrieval of Choledocholithiasis , 2006, Yonsei medical journal.

[9]  M. E. Ryan,et al.  Endoscopic balloon dilation compared with sphincterotomy for extraction of bile duct stones. , 2004, Gastroenterology.

[10]  J. Thompson,et al.  Endoscopic balloon dilatation versus endoscopic sphincterotomy for the removal of bile duct stones: a prospective randomised trial , 2003, Gut.

[11]  F. Gunsar,et al.  Biliary sphincterotomy plus dilation with a large balloon for bile duct stones that are difficult to extract. , 2003, Gastrointestinal endoscopy.

[12]  J. Tijssen,et al.  Randomised trial of endoscopic balloon dilation versus endoscopic sphincterotomy for removal of bileduct stones , 1997, The Lancet.

[13]  J. Tijssen,et al.  Long-term follow-up after endoscopic sphincterotomy for bile duct stones in patients younger than 60 years of age. , 1996, Gastrointestinal endoscopy.

[14]  M E Ryan,et al.  Complications of endoscopic biliary sphincterotomy. , 1996, The New England journal of medicine.

[15]  C Liguory,et al.  Endoscopic sphincterotomy complications and their management: an attempt at consensus. , 1991, Gastrointestinal endoscopy.

[16]  E. Faragher,et al.  Endoscopic sphincterotomy: The whole truth , 1991, The British journal of surgery.

[17]  P. Cotton,et al.  Follow-up 6 to 11 years after duodenoscopic sphincterotomy for stones in patients with prior cholecystectomy. , 1990, Gastroenterology.