Retrospective Study
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World J Gastroenterol. Dec 21, 2014; 20(47): 17962-17969
Published online Dec 21, 2014. doi: 10.3748/wjg.v20.i47.17962
Small sphincterotomy combined with endoscopic papillary large balloon dilation vs sphincterotomy alone for removal of common bile duct stones
Shi-Bin Guo, Hua Meng, Zhi-Jun Duan, Chun-Yan Li
Shi-Bin Guo, Department of Gastroenterological Endoscopy, the First Affiliated Hospital of Dalian Medical University, Dalian 116011, Liaoning Province, China
Hua Meng, Zhi-Jun Duan, Chun-Yan Li, Department of Gastroenterology, the First Affiliated Hospital of Dalian Medical University, Dalian 116011, Liaoning Province, China
Author contributions: Guo SB and Duan ZJ designed the study; Meng H and Li CY collected and analyzed the data; Guo SB wrote the manuscript; Guo SB and Meng H contributed equally to the study; all authors read and approved the final manuscript.
Correspondence to: Shi-Bin Guo, MD, PhD, Department of Gastroenterological Endoscopy, the First Affiliated Hospital of Dalian Medical University, No. 222 Zhongshan road, Xigang district, Dalian 116011, Liaoning Province, China. gsb@dl.cn
Telephone: +86-411-83635963 Fax: +86-411-83632383
Received: April 23, 2014
Revised: July 13, 2014
Accepted: August 13, 2014
Published online: December 21, 2014
Processing time: 241 Days and 0.3 Hours
Abstract

AIM: To evaluate the efficacy and safety of endoscopic papillary large diameter balloon dilation (EPLBD) following limited endoscopic sphincterotomy (EST) and EST alone for removal of large common bile duct (CBD) stones.

METHODS: We retrospectively compared EST + EPLBD (group A, n = 64) with EST alone (group B, n = 89) for the treatment of large or multiple bile duct stones. The success rate of stone clearance, procedure-related complications and incidents, frequency of mechanical lithotripsy use, and recurrent stones were recorded.

RESULTS: There was no statistically significant difference between the two groups regarding periampullary diverticula (35.9% vs 34.8%, P > 0.05), pre-cut sphincterotomy (6.3% vs 6.7%, P > 0.05), size (12.1 ± 2.0 mm vs 12.9 ± 2.6 mm, P > 0.05) and number (2.2 ± 1.9 vs 2.4 ± 2.1, P > 0.05) of stones or the diameters of CBD (15.1 ± 3.3 mm vs 15.4 ± 3.6 mm, P > 0.05). The rates of overall stone removal and stone removal in the first session were not significantly different between the two groups [62/64 (96.9%) vs 84/89 (94.4%), P > 0.05; and 58/64 (90.6%) vs 79/89 (88.8%), P > 0.05, respectively]. The rates of post-endoscopic retrograde cholangiopancreatography pancreatitis and hyperamylasemia were not significantly different between the two groups [3/64 (4.7%) vs 4/89 (4.5%), P > 0.05; 7/64 (10.9%) vs 9/89 (10.1%), P > 0.05, respectively]. There were no cases of perforation, acute cholangitis, or cholecystitis in the two groups. The rate of bleeding and the recurrence of CBD stones were significantly lower in group A than in group B [1/64 (1.6%) vs 5/89 (5.6%), P < 0.05; 1/64 (1.6%) vs 6/89 (6.7%), P < 0.05, respectively].

CONCLUSION: EST + EPLBD is an effective and safe endoscopic approach for removing large or multiple CBD stones.

Keywords: Choledocholithiasis; Endoscopic retrograde cholangiopancreatography; Endoscopic papillary balloon dilation; Endoscopic sphincterotomy

Core tip: Endoscopic papillary large diameter balloon dilation (EPLBD) after limited endoscopic sphincterotomy (EST) is an effective and safe endoscopic approach to remove large or multiple common bile duct stones. Compared with EST alone, the rate of bleeding and recurrence of CBD stones were significantly lower in the EST + EPLBD group (1.6% vs 5.6%, P < 0.05; 1.6% vs 6.7%, P < 0.05, respectively). While the rates of overall stone removal and stone removal in the first session (96.9% vs 94.4%, P > 0.05; 90.6% vs 88.8%, P > 0.05, respectively) and the rates of post-endoscopic retrograde cholangiopancreatography pancreatitis and hyperamylasemia were not significantly different between the two groups (4.7% vs 4.5%, P > 0.05; 10.9% vs 10.1%, P > 0.05, respectively).