Sphinterotomy Plus Large Balloon Papillary Dilatation for Large Bile Duct Stones

Abstract

Backgraound: One of the main problems in removing CBD stone is large stone size (>15 mm). It requires prolonged time and repeated procedure to remove large CBD stone. And there is higher risk of bleeding during wide EST. The aim of this study was to determine the utility of paillary dilatation with large balloon after EST. Method: Seventy patients with large (>15 mm) CBD stone were enrolled for this study. The patients underwent papillary dilatation with a 15 mm or 20 mm diameter balloon after EST (mid-incisoin). Then, stones were extracted by basket. And additional mechanical lithotripsy was done when stone removal was unsuccessful. Result: The maximum stone diameter was 21.5 mm. Average number of stones was 1.4. Periampullary diverticulum was found in 16 patient. Complete stone removal was achieved in all patient. We used 15 mm balloon in 25 patient, 20 mm balloon in 45 patient. And we needed mechanical lithotripsy in 11 patients in whom stone removal was unsuccessful by basket extraction. After the procedure, the serum amylase and/or lipase levels were elevated in 9 patients (12%). But, true pancreatitis was noted in only three patient (4%). Minor bleeding was encountered in 10 patients (14%) and was controlled spontaneously or by balloon compression. There was no critical complication such as perforation, severe pancreatitis, active bleeding or death. Conclusion: Large balloon papillary dilatation after EST is safe and effective method for treatment of large CBD stones. And this method can reduce the procedure time or repeated ERCP.