Balloon Sphincteroplasty Research Articles

Evaluation of pancreatic main ductal pressure and serum amylase on before and after endoscopic balloon sphincteroplasty(EBS) of oddi for bile duct stones

Evaluation of pancreatic main ductal pressure and serum amylase on before and after endoscopic balloon sphincteroplasty(EBS) of oddi for bile duct stones

Assessment of residual bile duct stones with use of intraductal US during endoscopic balloon sphincteroplasty: comparison with balloon cholangiography

Background: We sought to determine the utility of intraductal ultrasonography (IDUS) in detecting residual bile duct stones during endoscopic balloon sphincteroplasty. Methods: Eighty-one consecutive patients with bile duct stones who underwent IDUS during endoscopic balloon sphincteroplasty were studied. IDUS was performed with a thin-caliber ultrasonic probe (diameter 2.0 mm, frequency 20 MHz) by a transpapillary route after stone extraction. When IDUS or balloon-retrograde cholangiography suggested residual stones, the bile duct was cleared again with a Dormia basket. Extraction of the stones was confirmed by direct duodenoscopic visualization. Videotapes of IDUS and cholangiograms were reviewed retrospectively without knowledge of the results of other diagnostic modalities. Results:In 27 of 81 patients (33%), IDUS detected small residual stones not seen on cholangiography. When stones were fragmented with mechanical lithotripsy, the accuracy of IDUS in detecting small residual stones was significantly greater than that of balloon-endoscopic retrograde cholangiography (95% vs 50%, p < 0.001). When the bile duct was greater than 10 mm in diameter, the accuracy of IDUS in detecting small residual stones was significantly greater than that of cholangiography (92% vs. 56%, p < 0.001). Conclusions: IDUS is useful for detecting small residual bile duct stones during endoscopic balloon sphincteroplasty when stones are fragmented by mechanical lithotripsy or when there is evidence of a dilated bile duct (>10 mm). (Gastrointest Endosc 1999;49:328-33)

Influence of bile duct diameter on the therapeutic quality of endoscopic balloon sphincteroplasty.

Endoscopic balloon sphincteroplasty (EBS) has been reported to be a safe alternative to sphincterotomy for the treatment of bile duct stones. We evaluated the factors which influence the therapeutic efficacy of EBS. A total of 118 consecutive patients with bile duct stones were treated by EBS. After conventional endoscopic retrograde cholangiography (ERC), EBS was done using a biliary dilation catheter (balloon diameter, 8mm). The duct was then cleared using Dormia baskets or retrievel balloon catheters. When the stones were greater than 8 mm in diameter, mechanical lithotripsy was performed before extraction. Complete stone clearance was assessed by balloon-ERC and intraductal ultrasonography. Therapeutic efficacy was assessed using univariate and multivariate analysis. Patients were classified into three groups according to the bile duct diameter: nondilated (bile duct < or = 10 mm), mildly dilated (10 mm < bile duct < or = 15 mm), and severely dilated group (bile duct > 15 mm). In 113 of 118 (96%) patients, the stones were completely cleared with one to six endoscopic sessions (mean 1.6 sessions). In the nondilated group, 24 of 28 (85%) patients were cleared of stones in one session (mean 1.2 sessions), without the use of mechanical lithotripsy in 23 of 28 (82 %) patients. In the mildly dilated group, 23 of 38 (61 %) patients were cleared of stones in one session (mean 1.5 sessions). In contrast, in the severely dilated group, only 16 of 52 (31 %) patients were cleared of stones in one session (mean 2.0 sessions). Stone size, number of stones, and use of mechanical lithotripsy were independent variables which influenced the success of stone clearance in one session after EBS. When EBS is done in patients with bile duct stones, bile duct diameter may be a good indicator of therapeutic efficacy. In patients with severely dilated bile ducts (> 15 mm), EBS is of limited effectiveness.

Balloon sphincteroplasty and delayed cholecystectomy: What is the risk for recurrent biliary obstruction?

Balloon sphincteroplasty and delayed cholecystectomy: What is the risk for recurrent biliary obstruction?

Long-term effect of endoscopic balloon sphincteroplasty on papillary function evaluated by nitroglycerin-stimulated cholescintigraphy

Long-term effect of endoscopic balloon sphincteroplasty on papillary function evaluated by nitroglycerin-stimulated cholescintigraphy

The Role of Endoscopic Balloon Sphincteroplasty in Patients with Gallbladder and Bile Duct Stones

We clarified the significance of endoscopic balloon sphincteroplasty (EBS) in the therapeutic treatment of biliary tract stones in the present era of laparoscopic cholecystectomy (LC). Patients with cholecysto-choledocholithiasis (n = 33) were treated by EBS. After endoscopic retrograde cholangiography (ERC), a balloon catheter (8 mm in diameter and 3 cm in width) was inserted into the bile duct using a guidewire, and positioned at the sphincter of Oddi. After inflating the balloon catheter, bile duct stones were removed by mechanical lithotripsy, a basket catheter, or a balloon catheter. In all patients, bile duct stones were removed by EBS without endoscopic sphincterotomy. No complication occurred except for 2 cases of mild pancreatitis, which was resolved within 48 hours. Twenty-four patients underwent LC before or after EBS. The remaining 9 patients did not undergo LC due to a poor-risk status for general anesthesia. None of them, however, experienced cholecystitis or colicky attacks after EBS. The combination of EBS and LC is an excellent method for treating cholecysto-choledocholithiasis.

The acute and long-term effect of balloon sphincteroplasty on papillary structure in pigs

Background: Balloon dilation or sphincteroplasty is emerging as a potentially safe and effective alternative to sphincterotomy in the management of bile duct stones. However, concerns related to the possible development of fibrosis or papillary stenosis led us to investigate the acute and long-term effects of balloon sphincteroplasty on papillary structure. Methods: Sixteen pigs (45 to 50 kg) underwent transduodenal cannulation of the bile duct while under general anesthesia. Balloon sphincteroplasty was performed in 10 pigs to a diameter of 8 mm at a pressure of 10 atm. Sphincterotomy was carried out in 3 pigs while 2 other untreated pigs acted as controls. Eleven animals were sacrificed at intervals from 15 to 120 minutes after balloon sphincteroplasty or sphincterotomy. The remaining 5 animals were sacrificed between 6 and 12 weeks later. Histologic sections through the papilla were assessed for evidence of morphologic changes. Results: When compared with controls, sections taken 15 to 120 minutes after balloon sphincteroplasty showed a progressive increase in acute inflammation extending transmurally. Intramucosal, but no transmural, hemorrhage was noted. No architectural distortion or smooth muscle disruption was observed in contrast to the transmural hemorrhage, smooth muscle disruption, and mucosal necrosis seen following sphincterotomy. After 6 to 12 weeks, mild chronic inflammation with follicular hyperplasia was present but no smooth muscle disruption or fibrosis was observed. Conclusion: Balloon sphincteroplasty causes an acute transmural inflammatory response and chronic follicular hyperplasia but is not associated with fibrosis or altered papillary architecture. (Gastrointest Endosc 1996;44:650-5.)

Effect of endoscopic balloon sphincteroplasty (EBS) on sphincter of Oddi-evaluation from the view point of endoscopic manometry

Effect of endoscopic balloon sphincteroplasty (EBS) on sphincter of Oddi-evaluation from the view point of endoscopic manometry

Technical report: Percutaneous transperitoneal balloon sphincteroplasty during laparoscopic cholecystectomy for choledocholithiasis

A 61-year-old lady presented with colicky upper abdominal pain and an episode of obstructive jaundice. An ultrasound (US) scan showed the presence of gallstones. An IV cholangiogram before laparoscopic cholecystectomy revealed a stone in the lower common bile duct. ERCP subsequently confirmed the presence of a 6 mm size stone in the common bile duct. Sphincterotomy was not technically possible due to failure of deep cannulation of the papilla, despite two attempts. The patient subsequently underwent laparoscopic cholecystectomy. At cholecystectomy the patient was found to have a small cystic duct and a dilated common bile duct. After cholecystectomy the common bile duct was punctured with a 3 piece nephrostomy needle (18g cannulla and 22 g needle Meadox UK Limited, Caddington, Bedfordshire, UK) through a percutaneous transperitoneal approach under laparoscopic guidance. Contrast was injected through the needle and the presence o fa 6mm size stone was confirmed. A 150cm long 0.035 straight guide-wire (Cordis Corporation, Miami, FL, USA) was passed through the needle into the common bile duct and manipulated through the ampulla into the duodenum under screening using an image intensifier. The nephrostomy needle was removed and the puncture site dilated using an 7 F dilator. A 5 F Angioplasty catheter with a 4 cm long 12 mm diameter balloon (Cordis Corporation, Miami, FL, USA) was passed over the wire and positioned at the site of the ampulla. The balloon was inflated and sphincteroplasty performed. The balloon was deflated, withdrawn, positioned behind the stone, inflated and the stone pushed through the sphincter into the duodenum. The guide-wire was then removed and contrast injected through catheter to confirm complete clearance of the duct. The catheter was removed and the puncture hole in the common bile duct closed with a purse string suture laparoscopically. The patient recovered from the procedure with no immediate or long term complications remaining well at follow-up one year following the procedure.

Endoscopic balloon sphincteroplasty (papillary dilation) for bile duct stones: Efficacy, safety, and follow-up in 100 patients

Background: Because sphincterotomy accounts for a major portion of the morbidity and mortality associated with ERCP, we have proposed endoscopic balloon papillary dilation or sphincteroplasty as an alternative. Methods: We report the outcome in a series of 100 patients in whom balloon sphincteroplasty was attempted for bile duct stones up to 20 mm in diameter, with a median follow-up of 16 months (range 6 to 30). Results: During one ERCP session using sphincteroplasty alone, the bile duct was cleared in 78%, mechanical lithotripsy being required in 10% for stones greater than 12 mm in diameter. Incomplete duct clearance was achieved in a further 4%, all of whom underwent repeat ERCP with successful duct clearance without recourse to sphincterotomy. Failure to clear the bile duct with sphincteroplasty in the remaining 18% was primarily related to large stone size (> 15 mm). Sphincterotomy was required to clear the duct in 7%. Another 6% comprised elderly high-risk patients with multiple large stones greater than 15 mm who were treated by stent insertion plus ursodeoxycholic acid. No papillary hemorrhage was observed; uncomplicated pancreatitis occurred in 5%. During a median follow-up of 16 months, 2% had recurrent symptomatic bile duct stones considered to have been unrecognized following the initial ERCP; these were removed after repeat sphincteroplasty. No clinical evidence of papillary stenosis was observed during follow-up. Conclusions: Endoscopic balloon papillary dilation or sphincteroplasty is a safe and effective alternative to sphincterotomy in the management of bile duct stones less than 12 mm; larger stones may require mechanical lithotripsy to facilitate duct clearance. (Gastrointest Endosc 1995;42:468-74.)

Endoscopic balloon sphincteroplasty (EBS) reduces the need for papillotomy: 2 year follow-up in 100 patients

Endoscopic balloon sphincteroplasty (EBS) reduces the need for papillotomy: 2 year follow-up in 100 patients

The acute effect of balloon sphincteroplasty on papillary structure: An animal study

The acute effect of balloon sphincteroplasty on papillary structure: An animal study

Endoscopic sphincteroplasty: a novel and safe alternative to papillotomy in the management of bile duct stones.

Removal of bile duct stones during endoscopic retrograde cholangiopancreatography (ERCP) usually includes papillotomy. Papillotomy is associated with occasional complications and in addition, the longterm sequelae of papillotomy in young patients having laparoscopic cholecystectomy remain unclear. As an alternative to papillotomy, this study prospectively evaluated the efficacy and safety of endoscopic balloon sphincteroplasty to facilitate bile duct clearance. Of 32 patients with bile duct stones (diameter 3-30 mm) at ERCP, sphincteroplasty was considered inappropriate in four patients because of stone size (> 20 mm) necessitating papillotomy for bile duct clearance. Sphincteroplasty was performed in the remaining 28 patients to permit duct clearance by dormier basket, balloon or mechanical lithotripsy. The bile duct was cleared in 22 patients (79%) while additional measures including papillotomy or stent insertion were required in the remaining six patients (21%) because of stone size or technical difficulties. There was no associated papillary haemorrhage. Pancreatitis was seen in one patient (4%) but resolved within 24 hours. Our preliminary experience suggests that sphincteroplasty is a safe and effective sphincter preservation technique that significantly reduces the necessity for papillotomy in the management of bile duct stones.

Balloon sphincteroplasty vs endoscopic papillotomy for bileduct stones

Balloon sphincteroplasty vs endoscopic papillotomy for bileduct stones