Abstract
BackgroundLethal pancreatitis has been reported after treatment for common bile duct stones using small endoscopic papillary balloon dilation.MethodsWe retrospectively evaluated the safety and efficacy of using large balloon dilation alone without the use of sphincterotomy for the treatment of large common bile duct stones in Kaohsiung Veterans General Hospital. Success rate of stone clearance, procedure-related adverse events and incidents, frequency of mechanical lithotripsy use, and recurrent stones were recorded.ResultsA total of 247 patients were reviewed in the current study. The mean age of the patients was 71.2 years. Most of them had comorbidities. Mean stone size was 16.4 mm. Among the patients, 132 (53.4%) had an intact gallbladder and 121 (49%) had a juxtapapillary diverticulum. The mean size of dilating balloon used was 13.2 mm. The mean duration of the dilating procedure was 4.7 min. There were 39 (15.8%) patients required the help of mechanical lithotripsy while retrieving the stones. The final success rate of complete retrieval of stones was 92.7%. The rate of pancreatic duct enhancement was 26.7% (66/247). There were 3 (1.2%) adverse events and 6 (2.4%) intra-procedure bleeding incidents. All patients recovered completely after conservative and endoscopic treatment respectively, and no procedure-related mortality was noted. 172 patients had a follow-up duration of more than 6 months and among these, 25 patients had recurrent common bile duct stones. It was significantly correlated to the common bile duct size (p = 0.036)ConclusionsEndoscopic papillary large balloon dilation alone is simple, safe, and effective in dealing with large common bile duct stones in relatively aged and debilitated patients.
Highlights
Lethal pancreatitis has been reported after treatment for common bile duct stones using small endoscopic papillary balloon dilation
Recent studies [10,11] have shown that Endoscopic sphincterotomy (EST) followed by large balloon dilation or large balloon dilation only [12] for the removal of large or difficult stones from the CBD have good efficacy and acceptable complication rates
Endoscopic papillary large balloon dilation (EPLBD) without EST is easier to manipulate than the combinatorial method and is more suitable for patients with concomitant large stones and bleeding tendency
Summary
Lethal pancreatitis has been reported after treatment for common bile duct stones using small endoscopic papillary balloon dilation. Endoscopic sphincterotomy (EST) is effective in the treatment of common bile duct stones (CBDS), with complete stone removal in 85%-90% of patients [1,2,3]. Recent studies [10,11] have shown that EST followed by large balloon dilation or large balloon dilation only [12] for the removal of large or difficult stones from the CBD have good efficacy and acceptable complication rates. Endoscopic papillary large balloon dilation (EPLBD) without EST is easier to manipulate than the combinatorial method and is more suitable for patients with concomitant large stones and bleeding tendency. In order to evaluate the efficacy and safety of EPLBD alone in the treatment of CBDS, we conducted a retrospective study to investigate the effect of this method in patients with large CBDS in our center
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