Percutaneous trans-cholecystic balloon dilation of the papilla for clearance of common bile duct stones

Abstract

Objective To investigate the effectiveness and morbidity and follow-up data of percutaneous trans-cholecystic balloon dilation of the papilla (PCDP)for clearance of common bile duct (CBD) calculi. Methods From Feb.2011 to Feb.2014, 41 patients with choledocholithiasis were admitted to Weihai Municipal Hospital, of which 20 cases were assigned to percutaneous trans-cholecystic balloon dilation of the papilla (TCDP) group, whereas 21 cases to endoscopic sphincterotomy (EST) group. Complete clearance rate of CBD calculi, rate of postoperative short-term complications including acute pancreatitis and cholangitis and hemobilia, filling and emptying function of gallbladder, rate of recurrent CBD stones, gallbladder stones and cholangitis rate as well as pneumobilia rate were compared between the two groups. Results There was no significant difference in complete clearance rate of CBD calculi, short-term complications, gallbladder stone recurrence during follow-up between the two groups. Significant differences were observed in a follow-up of 24 months between TCDP group and EST group in pneumobilia rate (16.7% vs 68.4%, P=0.006), rate of recurrent CBD stones (5.6% vs 36.8%, P=0.025), fasting gallbladder volume [(20.9±3.2)ml vs(12.6±2.5)ml, t=8.82, P<0.01], gallbladder contractibility after a meal [(10.2±2.4)ml vs (6.6±1.7)ml, t=5.29, P<0.01], and cholangitis rate (11.1% vs 42.1%, P=0.034). Conclusions Balloon dilation of the papilla via percutaneous trans-cholecystic cannulation was as safe and effective as endoscopic sphincterotomy for removal of CBD stones. The technique of TCDP has the advantage in preserving the function of sphincter of Oddi and gallbladder as well as lower rate of postoperative recurrent CBD calculi in 2 years′ follow-up. Key words: Choledocholithiasis; Ampulla of Vater; Papillary balloon dilation; Sphincterotomy, endoscopic