Endoscopic Papillary Balloon Dilation Research Articles

Curative effects and prognosis of endoscopic papillary large balloon dilatation on the treatment of choledocholithiasis

Objective To evaluate the curative effect and prognosis of endoscopic papillary large balloon dilatation (EPLBD) in the treatment of choledocholithiasis. Methods A total of 153 patients with choledocholithiasis (>1.0 cm in stone diameter) admitted and treated in Shanxi People′s Hospital from August 2016 to November 2017 were randomly divided into two groups according to the random number table: the EPLBD group (n=83) and the small endoscopic sphincterotomy plus large balloon dilatation (ESLBD) group (n=70) . The success rate of stone removal, the rate of lithotripsy, and the incidence of short-term and long-term complications were compared between the two groups. Results There were no statistical differences between the EPLBD group and the ESLBD group in total stone removal rate [95.2% (79/83) VS 97.1% (68/70) , χ2=0.388, P=0.533] and one-time stone removal rate [92.8% (77/83) VS 90.0% (63/70) , χ2=0.375, P=0.540]. The lithotripsy rate between the two groups had no statistical difference [25.3% (21/83) VS 35.7% (25/70) , χ2=1.958, P=0.162]. There was no statistical difference in the incidence of recent complications between the two groups [43.4% (36/83) VS 40.0% (28/70) , χ2=0.178, P=0.673]. No postoperative perforation was found in either group. The follow-up time was 22.7±4.3 months in the EPLBD group, and 20.8±6.3 months in the ESLBD group.The cumulative recurrent rate of choledocholithiasis in the two groups were 2.4% (2/83) and 15.7% (11/70) , respectively, and the difference was significant (P=0.003) . Conclusion Simple EPLBD in the treatment of choledocholithiasis is equivalent to ESLBD in the success rate of stone removal, utilization rate of lithotripsy, and incidence of recent complications, but the long-term stone recurrence rate of EPLBD is lower than that of ESLBD. EPLBD is effective and safe on the treatment of choledocholithiasis. Key words: Choledocholithiasis; Cholangiopancreatography, endoscopic retrograde; Endoscopic papillary large balloon dilatation; Small endoscopic sphincterotomy plus large balloon dilatation

The efficacy of limited endoscopic sphincterotomy plus endoscopic papillary large balloon dilation for removal of large bile duct stones

BackgroundThe removal of large bile duct stones (> 15 mm) by conventional endoscopic sphincterotomy (EST) and endoscopic papillary balloon dilation (EPBD) can be challenging, requiring mechanical lithotripsy (ML) in addition to EST or EPBD. The primary complication of ML is basket and stone impaction, which can lead to complications such as pancreatitis and cholangitis. The present study aims to investigate the efficacy of limited EST plus endoscopic papillary large balloon dilation (EST-EPLBD) for large bile duct stone extraction with an extent of cutting < 1/2 the length of the papillary mound.MethodsWe enrolled 185 patients with ≥15 mm bile duct stones who received EST, EPLBD and limited EST-EPLBD treatment from January 1, 2010 to February 28, 2018, at Kaohsiung Chang Gung Memorial Hospital (Kaohsiung, Taiwan). All patients were categorized into three groups: EST group (n = 31), EPLBD group (n = 96), and limited EST-EPLBD group (n = 58). The primary outcome variables were the success rate of complete stone removal and complications.ResultsThe limited EST-EPLBD group exhibited a higher success rate of the first-session treatment compared with the EST and EPLBD groups (98.3% vs. 83.9% vs. 86.5%; P = 0.032) but required a longer procedure time (32 (12–61) min vs. 23.5 (17–68) min vs. 25.0 (14–60) min; P = 0.001). The need for ML during the procedure was 4 (12.9%) in the EST group, 10 (10.4%) in the EPLBD group and 2 (3.4%) in the limited EST-EPLBD group. Post-procedure bleeding in the EST group was more common than that in the limited EST-EPLBD group (9.7% vs. 0%; P = 0.038). Furthermore, dilated bile duct was the only risk factor for bile duct stone recurrence in the limited EST-EPLBD group.ConclusionsLimited EST-EPLBD exhibits a higher success rate but requires marginally longer procedure time for the first-session treatment. Furthermore, dilated bile duct is the only risk factor for bile duct stone recurrence in patients undergoing limited EST-EPLBD.

Prophylactic efficacy of a novel method against postendoscopic papillary balloon dilation pancreatitis.

This study aimed to investigate whether a novel method including prophylactic pancreatic stent (PS) placement prevents postendoscopic papillary balloon dilation pancreatitis. This study enrolled 200 consecutive patients with bile duct stones measuring up to 8 mm in diameter and retrospectively recruited 113 patients undergoing ordinary endoscopic papillary balloon dilation (EPBD) without PS placement from our previous study. In the novel method, EPBD and PS placement was attempted with a guidewire left in the main pancreatic duct for patients in whom stable guidewire placement in the main pancreatic duct was possible. EST was performed for patients in whom stable guidewire placement was impossible. The incidence rate of pancreatitis was compared between the novel method and ordinary EPBD, and risk factors for pancreatitis were analyzed. Of 194 patients undergoing the novel method, EPBD and EST were performed in 180 and 14 patients, respectively. Following EPBD, PS placement was successful in 177/180 (98.3%) of patients. Pancreatitis occurred in 7/194 (3.6%) of patients after the novel method and 9/113 (8.0%) of patients after ordinary EPBD. There was a trend toward lower incidence rate of pancreatitis in the novel method. Stent dislodgement by the first postoperative morning and no previous endoscopic nasobiliary drainage (ENBD) were identified as risk factors for pancreatitis after EPBD with PS placement. No previous ENBD was also identified as a risk factor for pancreatitis after ordinary EPBD. Our novel method is likely to be superior to ordinary EPBD in preventing pancreatitis. Previous ENBD may prevent post-EPBD pancreatitis regardless of PS placement.

Endoscopic papillary balloon dilation in treatment of choledocholithiasis associated with peripapillary duodenal diverticulum

Objective To evaluate the use of endoscopic papillary balloon dilation in treatment of choledocholithiasis associated with peripapillary duodenal diverticulum. Methods From January 2017 to July 2018, a retrospective study was conducted on 124 patients with choledocholithiasis associated with peripapillary duodenal diverticula at the Department of Hepatobiliary Surgery, Second Hospital of Hebei Medical University. These patients were divided into the small endoscopic sphincterotomy combined with balloon dilation group (sEST+ EPBD, n=60) and the simple papillary balloon dilation group (EPBD n=64). The operation time, one-time success rate of stone removal, complication and hospitalization stay were compared between the two groups of patients. Results The hospitalization expenses of the EPBD group was significantly less than the sEST+ EPBD group (P 0.05). Conclusions Compared with sEST+ EPBD, treatment of choledocholithiasis in patients with peripapillary duodenal diverticula using simple balloon dilation shortened the operation time, did not increase the complication rates and hospitalization stay. The procedure was safe and effective, and resulted in almost the same one-time success rate of stone removal. Key words: Endoscopic retrograde cholangiopancreatography; Parapapillary duodenal diverticula; Choledocholithiasis; Endoscopic papillary balloon dilation

Endoscopic Papillary Large Balloon Dilation Versus Endoscopic Sphincterotomy for Treatment of Bile Duct Stones.

To review the current literature focusing on the indications, efficacy, and safety of endoscopic papillary balloon dilation (EPBD) and endoscopic papillary large balloon dilation (EPLBD) with or without endoscopic sphincterotomy (EST) in the treatment of bile duct stones. • EPBD without EST is associated with a higher risk of post-procedural pancreatitis and lower rate of stone clearance than EST alone. • EPBD without EST should be at least 2min in duration, and placement of a pancreatic stent and other measures to reduce pancreatitis risk should be considered. • EPBD without EST is most useful to reduce risk of bleeding in patients with coagulopathy. • EPLBD combined with EST can be used as an alternative or adjunct to mechanical lithotripsy in the removal of large or difficult bile duct stones. • EPLBD combined with EST results in fewer complications than EST alone for removal of bile duct stones.

Multiple recurrences after endoscopic removal of common bile duct stones: A retrospective analysis of 976 cases.

Recurrences after endoscopic treatment of common bile duct stones (CBDS) are common. The aims of this study were to identify risk factors for recurrences of CBDS and to evaluate the effect of interventions for prevention of further recurrences. A total of 976 patients who underwent endoscopic treatment of CBDS were retrospectively studied. Risk factors for single and multiple recurrent CBDS were evaluated using a Cox hazard regression model. The incidences of further recurrences were evaluated according to the additional interventions. The mean age was 69.3years, and 39.3% were female. Endoscopic papillary balloon dilation, endoscopic sphincterotomy, and endoscopic papillary large balloon dilation were performed in 858, 77, and 41 patients, respectively. The rates of one or more recurrence and multiple recurrences of CBDS were 12.4% and 2.7%, respectively. In the multivariate analyses, the significant risk factors were the bile duct size (hazard ratio [HR] 1.07, P=0.012), gallbladder left in situ with stones (HR 1.91, P=0.046), and pneumobilia after treatment (HR 2.10, P=0.047) for single recurrence and the number of stones at the first recurrence (HR 1.16, P=0.021) for multiple recurrences. In five out of nine cases with multiple recurrences, further recurrence was not observed after additional sphincteroplasty in addition to cholecystectomy. The incidence of multiple recurrences was not uncommon after the first recurrence of CBDS.

Endoscopic retrograde cholangiopancreatography, lights and shadows: Handle with care.

The role of endoscopic retrograde cholangiopancreatography (ERCP) has dramatically changed in the last years, mainly into that of a therapeutic procedure. The treatment of benign biliary disease, like “difficult” choledocolithiasis, with endoscopic papillary large balloon dilation combined with endoscopic sphinterotomy has proven an effective and safe technique. Moreover, safety in ERCP has improved as well, with the prevention of post-ERCP pancreatitis and patient-to-patient transmission of infections. The advent of self-expandable metal stenting has radically changed the management of biliopancreatic malignant strictures, while the role for therapy of benign strictures is still controversial. In addition, cholangioscopy (though the direct visualization of the biliopancreatic ductal system) has allowed for characterization of indeterminate biliary strictures and facilitated rescue therapy of large biliary stones deemed removable. Encouraging data from tissue ablation techniques, such as photodynamic therapy and radiofrequency ablation, need to be confirmed by large sample size clinical controlled trials. On the other hand, we have no drug-coated stents yet available to implant and evidence for the use of biodegradable stents is still weak. The competency and privileging of ERCP and endoscopic ultrasonography have been analyzed longer but the switch between the two procedures, at the same time, is becoming ordinary; as such, the endoscopist interested in this field should undergo parallel edification through training plans. Finally, the American Society for Gastrointestinal Endoscopy’s statement on non-anesthesiologist administration of propofol for gastrointestinal endoscopy is not actually endorsed by the European Society of Anaesthesiology, having many medical-legal implications in some European countries.

Risk of cholangiocarcinoma in patients undergoing therapeutic endoscopic retrograde cholangiopancreatography or cholecystectomy: A population based study.

BACKGROUNDCholangiocarcinoma is a highly lethal disease that had been underestimated in the past two decades. Many risk factors are well documented for in cholangiocarcinoma, but the impacts of advanced biliary interventions, like endoscopic sphincterotomy (ES), endoscopic papillary balloon dilatation (EPBD), and cholecystectomy, are inconsistent in the previous literature.AIMTo clarify the risks of cholangiocarcinoma after ES/EPBD, cholecystectomy or no intervention for cholelithiasis using the National Health Insurance Research Database (NHIRD).METHODSFrom data of NHIRD 2004-2011 in Taiwan, we selected 7938 cholelithiasis cases as well as 23814 control group cases (matched by sex and age in a 1:3 ratio). We compared the previous risk factors of cholangiocarcinoma and cholangiocarcinoma rate in the cholelithiasis and control groups. The incidences of total and subsequent cholangiocarcinoma were calculated in ES/EPBD patients, cholecystectomy patients, cholelithiasis patients without intervention, and groups from the normal population.RESULTSIn total, 537 cases underwent ES/EPBD, 1743 cases underwent cholecystectomy, and 5658 cholelithiasis cases had no intervention. Eleven (2.05%), 37 (0.65%), and 7 (0.40%) subsequent cholangiocarcinoma cases were diagnosed in the ES/EPBD, no intervention, and cholecystectomy groups, respectively, and the odds ratio for subsequent cholangiocarcinoma was 3.13 in the ES/EPBD group and 0.61 in the cholecystectomy group when compared with the no intervention group.CONCLUSIONIn conclusion, symptomatic cholelithiasis patients who undergo cholecystectomy can reduce the incidence of subsequent cholangiocarcinoma, while cholelithiasis patients who undergo ES/EPBD are at a great risk of subsequent cholangiocarcinoma according to our findings.

Risk factors of acute pancreatitis after endoscopic retrograde cholangiopancreatography

Objective To investigate the risk factors of acute pancreatitis after endoscopic retrograde chloangiopancreatography (ERCP). Methods Clinical date of 1 041 patients who underwent therapeutic ERCP from January 2016 to August 2017 in department of gastroenterology, Zhongnan Hospital of Wuhan University, were retrospectively studied. Among them post-ERCP pancreatitis developed in 53 patients (PEP group) and the remaining 988 patients were assigned in the non-PEP group. The clinical characteristics, procedures of ERCP, gastrointestinal symptoms and laboratory findings after ERCP were compared between two groups. The SPSS software (version 22.0) was applied to analyze the risk factors of PEP. Results The overall incidence rate of PEP was 5.09% (53/1 041). There were statistic difference in the number of white cells [8.56 (5.43, 12.23) ×109/L vs. 7.12 (5.58, 9.20) ×109/L, Z=-2.122] and the ratio of neutrophils [0.82±0.11 vs. 0.76±0.12, t=-3.612] after ERCP operation; the incidence of endoscopic sphincterotomy (EST) [60.37%(32/53) vs. 43.72% (432/988) , χ2=5.646] and endoscopic papillary balloon dilation (EPBD)[50.94% (27/53) vs. 33.00% (326/988) , χ2=7.230] during operation, and periampullary diverticula [35.85% (19/53) vs. 52.98% (523/988) , χ2=4.619] (all P<0.05). Logistic analysis indicated that the ratio of neutrophils was independent risk factor of PEP (OR=1.058, 95%CI: 1.019-1.098, P=0.003) . Conclusion The number of white cells, the ratio of neutrophils after ERCP and endoscopic sphincterotomy, endoscopic papillary balloon dilation and periampullary diverticula are associated with PEP, while the ratio of neutrophils is the independent risk factor of PEP. Key words: Cholangiopancreatography, endoscopic retrograde; Pancreatitis; Risk factors

Endoscopic papillary large balloon dilation without sphincterotomy for users of antithrombotic agents: A multicenter retrospective study.

With an aging population, an increasing number of individuals on antithrombotic agents are diagnosed with large bile duct stones. Studies have shown the effectiveness of endoscopic papillary large balloon dilation (EPLBD) for removal of large bile duct stones. EPLBD without endoscopic sphincterotomy (EST) may reduce the risk of procedure-related bleeding, but the safety of this procedure for users of antithrombotic agents remains unclear. In this multicenter retrospective study, we included patients who underwent EPLBD without EST for bile duct stones between March 2008 and December 2017. We compared adverse events and other clinical outcomes between users and non-users of antithrombotic agents (antiplatelet agents and anticoagulants). We analyzed a total of 144 patients (47 users and 97 non-users of antithrombotic agents). Among the users, the agents were continued in 13% and were replaced with heparin in 62% during the periprocedural period. We did not observe clinically significant bleeding and thrombotic events irrespective of the use of antithrombotic agents. Overall rate of early adverse events did not differ between users and non-users (6.4% and 7.2%, P = 0.99). Procedural outcomes did not differ between the groups (necessity for lithotripsy, 28% vs. 29%; and complete stone removal in a single session, 72% vs. 71%, for users and non-users, respectively). Endoscopic papillary large balloon dilation without EST may be done without a substantial increase in procedure-related bleeding for users of antithrombotic agents. A larger study is required to refine the management strategy for those agents during the periprocedural period.

A cumulative meta-analysis of endoscopic papillary balloon dilation versus endoscopic sphincterotomy for removal of common bile duct stones

Endoscopic papillary balloon dilation (EPBD) was introduced to overcome the risk of adverse events associated with endoscopic sphincterotomy in the removal of common bile duct (CBD) stones. We performed a meta-analysis of randomized controlled trials (RCTs) comparing efficacy and safety of EPBD vs. endoscopic sphincterotomy, focusing on stone size, balloon diameter, and balloon dilation time. A multiple database search was performed, including MEDLINE, EMBASE and Cochrane Library, from their inception date until October 2017. RCTs comparing the efficacy and safety of EPBD vs. endoscopic sphincterotomy in the removal of CBD stones were included. Cumulative meta-analyses over time, and subgroup analyses according to stone size, and balloon diameter and dilation time were carried out. 25 RCTs met the inclusion criteria. Despite the cumulative meta-analysis showing a trend over time in favor of endoscopic sphincterotomy in studies published up to 2004, the conventional meta-analysis revealed that EPBD was equally efficacious compared with endoscopic sphincterotomy in stone removal at first attempt (odds ratio [OR] 0.95, 95 % confidence interval [CI] 0.65 - 1.38). Endoscopic sphincterotomy was superior to EPBD in terms of overall stone clearance (OR 0.65, 95 %CI 0.43 - 0.99) in studies published since 2002, but no differences emerged in studies using large ( ≥ 10 mm) balloons (OR 1.37, 95 %CI 0.72 - 2.62). No statistically significant difference in pancreatitis occurrence emerged between EPBD and endoscopic sphincterotomy (OR 1.35, 95 %CI 0.90 - 2.03). Pancreatitis was more common with EPBD than with endoscopic sphincterotomy in studies using balloons < 10 mm (OR 1.78, 95 %CI 1.07 - 2.97), whereas no difference emerged in studies using large balloons (OR 0.84, 95 %CI 0.46 - 1.53). EPBD had lower rates of bleeding and cholecystitis. Our latest data confirm that EPBD is currently inferior to endoscopic sphincterotomy in terms of overall stone clearance. However, EPBD using large balloons (≥ 10 mm) was as effective as endoscopic sphincterotomy, both in stone clearance and the need for endoscopic mechanical lithotripsy, without carrying an increased risk of pancreatitis.

Comparison of endoscopic papillary large balloon dilation with and without a prior endoscopic sphincterotomy for the treatment of patients with large and/or multiple common bile duct stones: a systematic review and meta-analysis.

AimTo compare endoscopic papillary large balloon dilation (EPLBD) alone with EPLBD following endoscopic sphincterotomy (EST) in patients with large and/or multiple common bile duct stones.MethodsWe conducted a comprehensive search of PubMed, EMBASE, and the Cochrane Library database to identify relevant available articles until July 19, 2018. Complete common bile duct stone (CBDS) removal rate, frequency of mechanical lithotripsy (ML) usage, total procedure time and intra- and postoperative adverse events were analyzed. We used RevMan 5.3 to perform the pooled analyses.ResultsSeven RCTs matched the selection criteria. A total of 369 patients underwent EPLBD alone, and 367 patients underwent EPLBD following EST. Our meta-analysis revealed that there were no significant differences in terms of initial success rate (OR =0.69, 95% CI=0.44–1.09, P=0.11), frequency of ML usage (OR =1.18, 95% CI=0.68–2.05, P=0.55), rate of post-endoscopy pancreatitis (PEP) (OR =0.88, 95% CI=0.43–1.78, P=0.72), total procedure time (MD =1.52, 95% CI=-0.13–3.17, P=0.07), or other intra- and postoperative adverse events between the groups for patients with large and/or multiple CBDSs.ConclusionsEPLBD alone was comparable to EPLBD with prior EST in patients with large and/or multiple CBDSs. Further studies are required to confirm the mechanisms of PEP in patients who accept EPLBD during endoscopic retrograde cholangiopancreatography (ERCP).

Japan Gastroenterological Endoscopy Society (JGES) clinical guidelines for endoscopic papillary large balloon dilation

Japan Gastroenterological Endoscopy Society (JGES) clinical guidelines for endoscopic papillary large balloon dilation

Is it necessary to perform sphincterotomy prior to endoscopic papillary large balloon dilation?

Is it necessary to perform sphincterotomy prior to endoscopic papillary large balloon dilation?

Biliary and pancreatic lithotripsy devices.

Background and AimsLithotripsy is a procedure for fragmentation or destruction of stones to facilitate their removal or passage from the biliary or pancreatic ducts. Although most stones may be removed endoscopically using conventional techniques such as endoscopic sphincterotomy in combination with balloon or basket extraction, lithotripsy may be required for clearance of large, impacted, or irregularly shaped stones. Several modalities have been described, including intracorporeal techniques such as mechanical lithotripsy (ML), electrohydraulic lithotripsy (EHL), and laser lithotripsy, as well as extracorporeal shock-wave lithotripsy (ESWL).MethodsIn this document, we review devices and methods for biliary and pancreatic lithotripsy and the evidence regarding efficacy, safety, and financial considerations.ResultsAlthough many difficult stones can be safely removed using ML, endoscopic papillary balloon dilation (EPBD) has emerged as an alternative that may lessen the need for ML and also reduce the rate of adverse events. EHL and laser lithotripsy are effective at ductal clearance when conventional techniques are unsuccessful, although they usually require direct visualization of the stone by the use of cholangiopancreatoscopy and are often limited to referral centers. ESWL is effective but often requires coordination with urologists and the placement of stents or drains with subsequent procedures for extracting stone fragments and, thus, may be associated with increased costs.ConclusionsSeveral lithotripsy techniques have been described that vary with respect to ease of use, generalizability, and cost. Overall, lithotripsy is a safe and effective treatment for difficult biliary and pancreatic duct stones.

Endoscopic papillary large balloon dilation and endoscopic papillary balloon dilation both without sphincterotomy for removal of large bile duct stones: A propensity-matched analysis.

Endoscopic papillary large balloon dilation (EPLBD) without endoscopic sphincterotomy (EST) may facilitate extraction of large bile duct stones through achieving adequate dilation of the ampulla. However, contrary to favorable long-term outcomes after endoscopic papillary balloon dilation (EPBD), that of EPLBD without EST has been little investigated. Therefore, we conducted the current study to evaluate short- and long-term outcomes of EPLBD without EST and EPBD after removal of large bile duct stones (LBDS; ≥10 mm). This retrospective study included patients without a previous history of EST, EPBD or EPLBD who underwent EPLBD without EST or EPBD for removal of LBDS. Each patient in the EPLBD without EST group was matched to a patient in the EPBD group using propensity scores. Forty-four patients in each group were matched for the analysis. Baseline characteristics were balanced after propensity matching. Rate of complete stone removal in a single session was higher (80% vs 16%, P < 0.001), number of ERCP sessions (1.3 ± 0.7 vs 2.4 ± 1.5, P < 0.001) and rate of lithotripsy use (30% vs 80%, P < 0.001) were smaller in the matched EPLBD without EST group. Contrary to null between-group differences in early adverse events (P = 0.99), a cumulative rate of late biliary complications was higher in the EPLBD without EST group (P = 0.02). EPLBD without EST showed higher efficacy for removal of LBDS but was associated with worse long-term outcomes when compared to EPBD.

Whether or Not to Cut When Performing Endoscopic Papillary Balloon Dilation

Although endoscopic papillary balloon dilation (EPBD) is widely performed after endoscopic biliary sphincterotomy (ES) to assist in the removal of

Comparison of the Long-Term Outcomes of Endoscopic Papillary Large Balloon Dilation Alone versus Endoscopic Sphincterotomy for Removal of Bile Duct Stones.

Background and Aims Endoscopic papillary large balloon dilation (EPLBD) alone is an alternative to endoscopic sphincterotomy (EST) for treatment of common bile duct (CBD) stones. However, limited data exists regarding comparison of the long-term outcomes for these techniques. In this study, we compared the long-term outcomes after EST with those after EPLBD alone for removal of CBD stones. Methods The records of patients with EST or EPLBD alone referred for CBD stones retrieval between June 2008 and July 2015 were retrospectively reviewed. Complete stone clearance, ERCP-related adverse events, and late biliary complications during long-term follow-up were analyzed. Results Basic patient characteristics were similar between the groups that underwent EST (n = 60) and EPLBD alone (n = 161). EPLBD compared with EST resulted in similar outcomes in terms of complete stone clearance (99.4% versus 100%, P = 0.54) and ERCP-related adverse events (6.8% versus 6.7%, P = 1.00). The mean duration of the follow-up was 74.5 months and 71.6 months who underwent EST and EPLBD alone, respectively (P = 0.42). Late biliary complications were occurred frequently in the EST group than in the EPLBD alone group (11 [18.6%] versus 16 [10.2%]), although the difference did not reach statistical significance (P = 0.11). Multivariate analysis showed that mechanical lithotripsy ([OR], 2.815; 95% CI, 1.148–6.902; P = 0.024) was significantly associated with late biliary complications. Conclusion As an alternative to EST, EPLBD has similar efficacy and safety for managing CBD stones. During long-term follow-up, patients who underwent EPLBD alone may have fewer late biliary complications compared with those after EST. In addition, mechanical lithotripsy may be an independent risk factor for late biliary complications.

Papillary Cannulation Facilitated by Submucosal Saline Injection into an Intradiverticular Papilla.

Endoscopic retrograde cholangiopancreatography (ERCP) of the intradiverticular papilla with its invisible orifice remains challenging. Several techniques have been introduced to evert the papillary opening to facilitate cannulation. A 79-year-old woman with bile duct stones underwent ERCP, which revealed that the papilla was located inside a large diverticulum and tended to rotate inward with a trial of papillary cannulation. Submucosal papillary injection of 3 cc of normal saline was performed at 3 and 9 o’clock. Eversion and fixation of a papilla in the diverticulum with this technique allowed selective cannulation of the biliary tree. Stones were retrieved after endoscopic papillary balloon dilation without complications. She had an uneventful post-procedural course. Our findings suggest that submucosal saline injection technique is safe and effective for selective cannulation and can be recommended when cannulation is very difficult because of an intradiverticular papilla.

Sa1366 ENDOSCOPIC PLACEMENT OF A PLASTIC SPIRAL STENT FOR SHORT-TERM BILIARY DRAINAGE IN PATIENTS WITH CHOLELITHIASIS.

There are no guidelines addressing whether a routine drainage should be performed after endoscopic stone extraction in patients with cholelithiasis. However, many endoscopists tend to insert a nasobiliary tube or a biliary stent for prevention of post-ERCP complications. The main concern is that potential residual debris or ampullary edema caused by repeated endoscopic manipulations may disturb normal biliary drainage. Considering the shortcomings of nasobiliary tube and regular stent,we designed a novel plastic spiral stent, which can be expelled in the help of intestinal peristalsis, avoiding repeated duodenoscopy for stent removal, as well as the discomfort caused by nasobiliary catheter. Evaluate the efficacy of a plastic spiral stent for short-term biliary drainage and whether it expelled automatically. : Over a 1-year period, 12 spiral stents were placed for short-term biliary drainage in 12 patients with cholelithiasis who underwent stones extraction by using of endoscopic sphincterotomy, endoscopic papillary balloon dilatation and/or mechanical lithotripsy. No post-ERCP pancreatitis or bleeding occurred, as well as stent related intestinal injuries. All biliary drainages were effective, and all inserted spiral stents were expelled automatically when the patients moved bowels. The median duration from stent placement to expulsion was 4 days (range 2 to 30). Endoscopic placement of a plastic spiral stent for short-term biliary drainage seems a promising therapy in selected patients.Table 1Patient characteristics.Patient numberSexAge, yearsStone numberStone size, cmEndoscopic interventionDuration from stent placement to expulsion, daysHospital stay after stent placement, days1F43Multiple1.6EST+EPBD222M78Single1.0EST+EPBD+ML373F63Multiple1.5EPBD324M60Multiple1.0EST+EPBD435M56Multiple0.9EST+ML436M80Multiple1.2EST+EPBD+ML437F53Multiple1.2EPBD+ML498F79Single0.7EST+ML1149F80Multiple1.4EST+EPBD+ML21*1010M79Multiple1.5EST+EPBD30*811F76Multiple1.6EST+EPBD+ML30*312F74Multiple1.5ML30*3F, female; M, male; EST, endoscopic sphincterotomy; EPBD, endoscopic papillary balloon dilatation; ML, mechanical lithotripsy; *Patient 8-12 did not notice the expelled spiral stents, the absence of which were proved by radiology. Open table in a new tab