Value of endoscopic sphincterotomy with small incision combined with balloon dilatation in the treatment of choledocholithiasis with juxtapapillary duodenal diverticula

Abstract

Objective To explore the efficacy of endoscopic sphincterotomy with small incision combined with balloon dilatation (sEST+ EPBD) in the treatment of patients with choledocholithiasis and juxtapapillary duodenal diverticula (JPDD). Methods From January 2011 to January 2015, 149 patients with choledocholithiasis and JPDD who underwent endoscopic retrograde cholangio-pancreatography (ERCP) were enrolled.Among them, 60 patients were in sEST+ EPBD group and 89 were in endoscopic sphincterotomy (EST) group. Success rate of ERCP and first-time stone removal, changes of total bilirubin (TBil) and direct bilirubin (DBil) levels, as well as the incidence of postoperative complications between the two groups were compared. Chi-square test or t-test was performed for statistical analysis. Results The ERCP success rate sEST+ EPBD group was 100.0%(60/60), and the first-time success rate of stone removal was 91.7%(55/60); correspondingly, ERCP success rate of EST group was 98.9%(88/89), and the success rate of first-time stone removal was 77.5%(69/89). There was no statistically significant difference in success rate of ERCP between the two groups (χ2=0.19, P=0.410). The first-time success rate of stone removal of sEST + EPBD group was higher than that of EST group, and the difference was statistically significant (χ2=5.53, P=0.020). After operation, the TBil level of sEST+ EPBD group was (152.62±109.04) μmol/L, which was lower than that before operation ((266.02±143.31) μmol/L), and the difference was statistically significant (t=4.88, P<0.01). After operation, the DBil level of sEST + EPBD group was (87.13±65.90) μmol/L, which was lower than that before operation ((175.70±100.53) μmol/L), and the difference was statistically significant (t=5.71, P<0.01). After operation, the TBil level of EST group was (251.90±247.90) μmol/L, which was lower than that before operation ((340.20±176.20) μmol/L), and the difference was statistically significant (t=2.74, P<0.05). After operation, the DBil level of EST group was (168.10±140.60) μmol/L, which was lower than that before operation ((228.40±139.60) μmol/L), and the difference was statistically significant (t=2.87, P=0.005). The complication rate of sEST+ EPBD group after operation was 8.3%(5/60), which was lower than that of EST group (20.2%, 18/89), and the difference was statistically significant (χ2=3.88, P=0.049). Conclusion sEST+ EPBD could increase the first-time success rate of stone removal in patients with choledocholithiasis and JPDD, and it is a safe and effective treatment. Key words: Choledocholithiasis; Juxtapapillary duodenal diverticula; Endoscopic sphincterotomies; Balloon dilatation