Brief Article
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World J Gastroenterol. Feb 14, 2013; 19(6): 903-908
Published online Feb 14, 2013. doi: 10.3748/wjg.v19.i6.903
Ampulla dilation with different sized balloons to remove common bile duct stones
Neng-Ping Li, Jiang-Qi Liu, Zhi-Qiang Zhou, Tao-Ying Ji, Xiao-Yan Cai, Qing-Yun Zhu
Neng-Ping Li, Jiang-Qi Liu, Zhi-Qiang Zhou, Tao-Ying Ji, Xiao-Yan Cai, Qing-Yun Zhu, Department of General Surgery, Shanghai Gongli Hospital, Shanghai 200135, China
Author contributions: Li NP designed and performed the study, analyzed data and wrote the manuscript; Liu JQ instructed the study and revised the manuscript; Zhou ZQ performed the study and collected and analyzed data; Ji TY followed up the patients and collected and analyzed data; Cai XY collected data and supplemented references; and Zhu QY revised the manuscript.
Supported by Shanghai Municipal Health Bureau, No. 201104369
Correspondence to: Neng-Ping Li, MS, Chief Doctor, Department of General Surgery, Shanghai Gongli Hospital, No. 219, Miaopu Road, Pudong New Area, Shanghai 200135, China. linengp@163.com
Telephone: +86-21-58858730 Fax: +86-21-38821635
Received: November 27, 2012
Revised: January 15, 2013
Accepted: January 29, 2013
Published online: February 14, 2013
Processing time: 82 Days and 23.7 Hours
Abstract

AIM: To assess the outcomes of ampulla dilation with different sized balloons to remove common bile duct (CBD) stones.

METHODS: Patients (n = 208) were divided into five groups based on the largest CBD stone size of < 5, 6-8, 8-12, 12-14, and > 14 mm. Patients underwent limited endoscopic sphincterotomy (EST) alone or limited EST followed by endoscopic papillary balloon dilation with 8, 10, 12 and 14 mm balloons, such that the size of each balloon did not exceed the size of the CBD. Short- and long-term outcomes, such as post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis, perforation, bleeding, and pneumobilia were compared among the five groups.

RESULTS: The overall rate of successful stone removal in all groups was 100%, and all patients were cured. Eight (3.85%) patients had post-ERCP pancreatitis, none had perforations, and 6 (2.9%) had bleeding requiring transfusion. There were no significant differences in early complication rates among the five groups. We observed significant correlations between increased balloon size and the short- and long-term rates of post-ERCP pneumobilia. Post-ERCP pancreatitis and bleeding correlated significantly with age, with post-ERCP pancreatitis occurring more frequently in patients aged < 60 years, and bleeding occurring more frequently in patients aged > 70 years. We observed a significant correlation between patient age and the diameter of the largest CBD stone, with stones > 12 mm occurring more frequently in patients > 60 years old.

CONCLUSION: Choosing a balloon size based on the largest stone diameter is safe and effective for removing CBD stones. Balloon size should not exceed 15 mm.

Keywords: Endoscopic papillary balloon dilation; Endoscopic sphincterotomy; Common bile duct stone; Endoscopic retrograde cholangiopancreatography; Pancreatitis