Small sphincterotomy combined with endoscopic papillary large balloon dilation versus sphincterotomy

Abstract

To compare small sphincterotomy combined with endoscopic papillary large balloon dilation (SES + ELBD) and endoscopic sphincterotomy (EST) for large bile duct stones. We compared prospectively SES + ELBD (group A, n = 27) with conventional EST (group B, n = 28) for the treatment of large bile duct stones (> or = 15 mm). When the stone could not be removed with a normal basket, mechanical lithotripsy was performed. We compared the rates of complete stone removal with one session and application of mechanical lithotripsy. No significant differences were observed in the mean largest stone size (A: 20.8 mm, B: 21.3 mm), bile duct diameter (A: 21.4 mm, B: 20.5 mm), number of stones (A: 2.2, B: 2.3), or procedure time (A: 18 min, B: 19 min) between the two groups. The rates of complete stone removal with one session was 85% in group A and 86% in group B (P = 0.473). Mechanical lithotripsy was required for stone removal in nine of 27 patients (33%) in group A and nine of 28 patients (32%, P = 0.527) in group B. SES + ELBD did not show significant benefits compared to conventional EST, especially for the removal of large (> or = 15 mm) bile duct stones.