Endoscopic large balloon papillosphincteroplasty for difficult bile duct stones combined with peripapillary diverticulum

Abstract

Objective To evaluate the effects and safety of endoscopic large balloon papillosphincteroplasty for difficult bile duct stones combined with peripapillary diverticulum. Methods Endoscopic sphincterotomy （EST） to 3-6 mm was performed in 21 patients with large bile duct stones combined with peripapillary duodenal diverticulum, after which the incision was dilated with a 10mm balloon, followed by endoscopic papillosphincteroplasty with a TTC balloon dilator of 16-20 mm in diameter according to the size of the dilated common bile duct and the stones. Then the stones were removed with a basket and/or a retrieval balloon. Results All the stones were removed with one endoscopic procedure without mechanical lithotripsy. The size of removed stones ranged from 1.3 to 2. 0 cm （mean 1.6 cm） , with 15 cases of single stone, 4 of 2 stones and 2 of 3 stones. Mild post-operative pancreatitis occurred in 2 patients and transient serum amylase elevation （ less than 3 times of normal upper range） was found in 2 other patients. There were no such procedure related complications as perforation, massive hemorrhage or infections. Conclusion Endoscopic large balloon papillosphincteroplasty is efficacious and safe for difficult bile duct stones combined with peripapillary duodenal diverticulum. Key words: Choledocholithiasis ; Diverticulum ; Dilatation ; Cholangiopancreatography, endoscopic retrograde