Limited endoscopic sphincterotomy plus balloon dilation (ESBD) for large choledocholithiasis accompanied with periampullary diverticula

Abstract

Objective To explore the effectiveness and safety of limited endoscopic sphincterotomy plus endoscopic papillary balloon dilation (ESBD) for patients with large common duct stones and periampullary diverticula (PAD). Methods Data of 40 patients with large common duct stones (diameter ≥10 mm) and PAD who underwent ESBD were retrospectively reviewed. The clinical feature, operation method, success rates of stone removal and early complications rates during hospitalization were evaluated according to PAD subtypes. Results The stone removal rate in first session was 90.0%(36/40, with a median time of 29 minutes per procedure. Three patients underwent a second procedure to remove residual stones. The overall stone removal rate was 97.5% (39/40). The early complications rate was 15%(6/40), including mild pancreatitis in two cases(5%), hyperamylasemia in two (5%), postoperative late bleeding in two (5%), which were cured with conservative treatment. No perforation, massive hemorrhage or death occurred. No significant differences in success stone removal rate and early complication rate were found between PAD subtypes. Conclusion ESBD is an effective and safe procedure for removing choledocholithiasis in patients with PAD, regardless of PAD subtypes. Key words: Cholangiopancreatography, endoscopic retrograde; Sphincterotomy, endoscopic; Large choledocholithiasis; Periampullary diverticula; Balloon dilation