Endoscopic papillary large balloon dilation for the treatment of recurrent bile duct stones in patients with prior sphincterotomy

Abstract

Endoscopic sphincterotomy (EST) is a standard procedure for the removal of bile duct stones. However, additional EST may increase the risk of bleeding and perforation in patients with prior EST. Endoscopic papillary large balloon dilation (EPLBD) can be an alternative method for removing recurrent common bile duct stones with lower risk of bleeding and perforation. The aim of this study was to evaluate the therapeutic outcomes and complications of EPLBD in patients with recurrent common duct stones who underwent EST previously. Between January 2006 and August 2009, 70 patients with recurrent bile duct stones who had a history of EST were studied retrospectively. All patients underwent EPLBD without additional EST to enlarge the ampullary orifice. The size of the balloon for EPLBD was 12-18 mm and the duration of the balloon dilatation was 30-60 s. Of the 70 patients, there were 24 patients (34.3%) with periampullary diverticula, 18 patients (25.7%) with hypertension, 4 patients (5.7%) with ischemic heart diseases, 2 patients (2.9%) with liver cirrhosis, and 1 patient (1.4%) with chronic kidney disease. Mean diameter of the stones was 12.5 ± 5.5 mm. Complete clearance of the duct was achieved in all patients and mechanical lithotripsy was needed in 1 patient (1.4%). Sixty-eight cases (97.1%) required only 1 session of ERCP to achieve complete ductal clearance. Mild pancreatitis occurred in 1 patient (2.3%), but there was no bleeding or perforation. EPLBD is an effective and safe method for the treatment of recurrent common duct stones in patients with prior EST.