Abstract
This study compared the therapeutic benefits and complication rates of small endoscopic sphincterotomy plus large-balloon dilation (ESLBD) with those of endoscopic sphincterotomy (EST) alone for large bile duct stones. We compared prospectively ESLBD group (n=63) with conventional EST group (n=69) for the treatment of large bile duct stones (≥15mm). Mechanical lithotripsy was performed when the stone could not be removed using a normal basket. We compared the rates of stone removal, frequency of mechanical lithotripsy use, procedure-related complications, and recurrent stones. A total of 132 patients were reviewed in the study. The mean age of the patients was 67.9 years. The two groups showed significant differences in complete stone removal during the first session (80.9 vs. 60.8%; P = 0.046), the use of mechanical lithotripsy (7.94 vs. 24.6%; P = 0.041), and less duration of admission (P =0.045). After ERCP, there were some instances of oozing in both groups, All patients recovered completely, 14 patients had recurrent common bile duct stones among the follow-up duration. The ESLBD technique seems to be a feasible and safe alternative technique for conventional EST and EBD and has no more Post-ERCP complications.
Highlights
Treatment of common bile duct stones (CBDS) is one of the main indications for Endoscopic retrograde cholangiopancreatography (ERCP)
The patients’ demographic characteristics are summarized in Table-I, Results of endoscopic stone removal after ESLBD vs endoscopic sphincterotomy (EST) alone are shown in Table-II, Complications in ESLBD and EST alone are compared in Table-III
The ESLBD group consisted of 32 men and 31 women, and the EST group consisted of 36 men and 33 women
Summary
Treatment of common bile duct stones (CBDS) is one of the main indications for Endoscopic retrograde cholangiopancreatography (ERCP). 5 to 10% of duct stones cannot be removed using either EST or EBD alone.[1] Stone extraction failure generally occurs with stones larger than 1.5 cm. Small endoscopic sphincterotomy plus large-balloon (12–20 mm) dilation (ESLBD) has recently been introduced as an adjunctive technique to enlarge the papillary orifice after EBS in order to facilitate removal large or difficult stones. We conducted a prospective randomized study to compare the therapeutic benefits and complications of ESLBD with conventional EST for the treatment of large (≥ 15 mm) common bile duct stones
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