Abstract
Introduction: Endoscopic retrograde cholangiopan-creatography (ERCP) with endoscopic sphincterotomy (ES) is the most widely used technique for treating choledocholithiasis. In some cases, due to anomalies of the papilla or the presence of large or multiple calculi, additional maneuvers are needed to remove the stones. The present study investigates the efficacy and safety of ES with sphincteroplasty (SP) in the management of choledocholithiasis with extraction difficulties. Patients and Methods: A prospective study was made of 153 patients with choledocholithiasis subjected to ERCP. Fifty-two patients underwent ES with SP, while 101 were subjected only to ES. The two groups were compared in terms of age, gender, percentage cannulation, presence of papilla alterations, large or multiple stones, success in stone removal and complications (acute pancreatitis, bleeding and perforation). In the ES with SP group, we moreover recorded the diameters of the balloons employed (10-18 mm). Results: There were no significant differences between the groups in the stone extraction success rate (94.23% in the ES with SP group versus 97.03% in the ES group) or in the appearance of complications (3.8% in the ES with SP group versus 2.7% in the ES group). The presence of difficult papillae, and of multiple or large stones was significantly greater in the ES with SP group. The diameter of the balloon was not associated with the appearance of complications. Conclusion: Endoscopic sphincterotomy with sphincteroplasty is effective and safe in the treatment of choledocholithiasis with extraction difficulties.
Highlights
Endoscopic retrograde cholangiopancreatography (ERCP) with endoscopic sphincterotomy (ES) is the most widely used technique for treating choledocholithiasis
There were no significant differences between the groups in the stone extraction success rate (94.23% in the ES with SP group versus 97.03% in the ES group) or in the appearance of complications (3.8% in the ES with SP group versus 2.7% in the ES group)
Bile duct cannulation was achieved in all patients: directly in 150 cases (98.08% in the ES with SP group and 98.02% in the ES group) and using precut in three cases (1 in the ES with SP group and 2 in the ES group)
Summary
Endoscopic retrograde cholangiopancreatography (ERCP) with endoscopic sphincterotomy (ES) is the most widely used technique for treating choledocholithiasis (CL) [1,2]. Mechanical lithotripsy was more often used, and if this technique failed, surgery was decided. The surgical option is more aggressive and involves greater morbidity and mortality than endoscopic treatment, in very elderly individuals, which are the typical type of patients that suffer CL. For these reasons, sphincteroplasty (SP) with dilating balloons was introduced in 2003 as a routine method for expanding endoscopic sphincterotomies that are found to be insufficient. Uribarrena-Amezaga et al / Open Journal of Gastroenterology 3 (2013) 241-248 ties, and to determine whether the complications are greater than when only ES is performed (Figure 1)
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
