The Effectiveness and Safety of Minor Endoscopic Sphincterotomy Plus Large Balloon Dilation for Removal of Bile Duct Stones in Patients with Periampullary Diverticula

Abstract

Background: Endoscopic sphincterotomy (EST) plus large balloon dilation (LBD) is a useful method to remove bile duct stones. PAD have been reported to be associated with the risk of complications and difficulty of stone removal. However, the effectiveness and safety of minor EST plus LBD in patients with PAD for removal of bile duct stones is not well known. Objective: The aim of this study is to evaluate the effectiveness and safety of minor EST plus LBD for removal of bile duct stones in patients with PAD. Patients and Intervention: Total one hundred thirty nine patients with bile duct stones were included. Among them, 73 patients (median age 70 years (40∼89); 37 men, 36 women) had PAD and 66 patients (median age 64 years (23∼89); 39 men, 27 women) had normal papilla. PAD were classified in 3 different types according to the position of the major duodenal papilla; type1, inside the diveticulum; type2, in the margin of the diverticulum; type3, near the diverticulum. LBD (10 to 20 mm balloon diameter) was performed after minor EST. Main outcome measurements: Successful stone removal and complications such as pancreatitis, bleeding. Results: The mean age was significantly increased in PAD group compared with normal group (69.9 vs 62.1, P< 0.001). PAD group compared with normal group resulted in similar outcomes in terms of overall complete stone removal (94.5% vs 93.9%), complete stone removal in single session (69.9% vs 81.8%), mechanical lithotripsy (12.3% vs 13.6%). Complications were similar between the 2 groups (11.0% vs 7.6%, P=0.497). Clinical outcomes according to types of PAD were similar. Conclusions: Minor EST plus LBD was effective and safe treatment modality for removing bile duct stones in patients with PAD. The types of PAD did not influence clinical outcome.