Comparison between endoscopic sphincterotomy combined with large-balloon dilation and endoscopic large-balloon dilation alone in removal of large bile duct stones

Abstract

Objective To compare the efficacy of endoscopic sphincterotomy (EST) combined with large-balloon dilation (LBD) and that of LBD alone for large bile duct stones. Methods Data of 61 patients who received EST combined with LBD (the combination group) and 48 patients who received LBD alone (the LBD group) from February 2008 to November 2014 were collected. The efficacy and adverse events of two groups were compared. Results The procedure time from successful cannulating to complete stone removal was shorter in the LBD group than that in the combination group [17.3 min (8-35 min) VS 21.5 min (10-42 min), P=0.041]. There were no significant differences in overall complete stone removal rate[90.2% (55/61) VS 91.7% (44/48), P=1.000] and complete stone removal rate without mechanical lithotripsy[78.7% (48/61) VS 83.3% (40/48), P=0.542] in the combination group and the LBD group. Massive bleeding occurred in one patient of the combination group, but was successfully coagulated under endoscopy. There was no significant difference in the incidence of postoperative pancreatitis between the two groups[4.9% (3/61) VS 6.3% (3/48), P=1.000]. Conclusion EST combined with LBD offers no significant advantage over LBD alone for the removal of large bile duct stones. LBD can simplify the procedure compared with EST combined with LBD in terms of shortening the procedure time. Key words: Choledocholithiasis; Endoscopic large-balloon dilation; Endoscopic sphincterotomy