Endoscopic sphincterotomy combined with large balloon dilation for bile duct stones

Abstract

Objective To evaluate the therapeutic efficacy and safety of endoscopic sphincterotomy （EST） combined with large balloon dilation for bile duct stones. Methods A total of 83 patients with com- mon bile duct stones were randomly divided into 2 groups to receive standard EST （n = 41, EST group） or EST plus large balloon dilation （ n = 42, EPLBD group） , respectively. The number of endoscopic session, operation time, rates of successful complete stone retrieval, mechanical lithotripsy, and procedure related complication were compared between the two groups. Results The rate of early procedure-related complica- tions was similar in 2 groups （9/41 vs. 7/42, P 〉 0. 05 ）, including perforation （ 1/41 vs. 0/42, P 〉 0. 05 ）, bleeding （5/41 vs. 2/42, P 〉0. 05） and pancreatitis （3/41 vs. 5/42, P 〉0. 05）. The rate of suc- cessful complete stone removal was also similar in 2 groups （39/41 vs. 41/42, P 〉 0. 05）. However, EST group needed more procedure time （38. 8 ± 4. 3 min vs. 29.2 ± 5.3 rain, P 〈 0. 01 ） and use of mechanical lithotripsy to achieve complete stone removal （9/41 vs. 2/42, P 〈 0. 05 ）. Only one patient in EPLBD group （ 1/42, 2.4% ） needed a second ERCP to clear bile duct stone, while in EST group, 8 patients underwent a second procedure （ 19. 5% , P 〈 0. 05）. Conclusion For endoscopic removal of common bile duct stones, EST combined with large balloon dilation is as safe and effective as EST, while easier in manipulation. Key words: Common bile duct calculi; Sphincterotomy; Endoscopic; Balloon dilatation