Minor EST with EPLBD Is a Safe Treatment Modality for Removal of Difficult Bile Duct Stones in Patients with Periampullary Diverticuli

Abstract

Background/Aims: Periampullary diverticuli (PAD), which are frequently noticed during endoscopic retrograde cholangiopancreatography (ERCP) examination in patients with pancreaticobiliary diseases, have been reported to be associated with difficult bile duct canulation and an increased incidence of endoscopic sphincterotomy (EST). The aim of this study is to investigate the safety of combined minor EST and endoscopic papillary large balloon dilatation (EPLBD) for the removal of difficult CBD stones in patients with periampullary diverticuli group by comparing the success rate of stone removal and complications with patients who have normal ampullas. Patients and Methods: Between May 2005 and Sep. 2006, 69 patients underwent minor EST with EPLBD for the removal of CBD stones. Thirty two patients(mean age 71.8 years; 12 men, 20 women) had periampullary diverticului and thirty seven patients(mean age 66.9 years; 17 men, 20 women) had normal ampulla. Results: The mean number of CBD stones was 2.5 in PAD and 3.2 in normal. The mean diameter of stones was 17.5 mm and 18.2 mm, respectively. The success rate of complete stone removal for first endosocopic session was 93.8% (30/32) in the PAD group and 89.2% (33/37) in the normal ampullary group (p > 0.05). The complication rate was 3.1% (1/32; delayed bleeding) in the PAD group and 10.8% (4/37; all were mild pancreatitis) in the normal ampullary group (p > 0.05). The overall success rate of stone removal was 100% in both group. Conclusion: Minor EST with EPLBD in PAD is a safe treatment modality for removal of large CBD stones.