Endoscopic Papillary Large Balloon Dilation Research Articles

Japan Gastroenterological Endoscopy Society guidelines for endoscopic papillary large balloon dilation.

The Japan Gastroenterological Endoscopy Society has developed the 'EPLBD Clinical Practice Guidelines' as fundamental guidelines based on new scientific techniques. EPLBD is a treatment method that has recently become widely used for choledocolithiasis. The evidence level in this field is usually low, and in many instances, the recommendation grading has to be determined on the basis of expert consensus. At this point, the guidelines are divided into the following six sections according to the 'EST Clinical Practice Guidelines': (i) Indications, (ii) procedures, (iii) special cases, (iv) procedure-related adverse events, (v) treatment outcomes, and (vi) postoperative follow up observation.

Endoscopic papillary large balloon dilation for common bile duct stones

Objective To study the clinical efficacy and safety of endoscopic papillary large balloon dilation (EPLBD) in the treatment of common bile duct (CBD) stones. Methods This retrospective study of EPLBD for CBD stoneswas conducted between May 2015 and March 2017 on 116 patients.The patients were divided into two groups based on the different methods of treatment: group A (the EPLBD group) and B(the EST+ EPBD group). Results Treatment with EPLBD when compared with EST+ EPBD produced similar outcomes with regard to the overall stone removal rates (96.2% vs. 93.5%, P>0.05) and complete ductal clearance in one session (92.6% vs. 92%, P>0.05). There were no significant differences in the rates of overall complication (22.2% vs. 22.2%, P>0.05), hemorrhage (7.4% vs. 11.3%, P>0.05), post-ERCP pancreatitis (9.3% vs. 6.6%, P>0.05) and acute cholangitis (5.6% vs. 8.1%, P>0.05). When compared with EST+ EPBD, mechanical lithotripsy was performed less in the EPLBD group (16.6% vs. 27.4%, P<0.05). Conclusions EPLBD was an effective and safe method to treat CBD stones. EPLBD reduced the use of mechanical lithotripsy when compared with EST+ EPBD. Key words: Endoscopic papillary large balloon dilatation (EPLBD); Endoscopic papillary balloon dilatation (EPBD); Common bile duct stone; Endoscopic retrograde cholangiopancreatography (ERCP); Endoscopic sphincterotomy (EST)

Complex biliary stones management: cholangioscopy versus papillary large balloon dilation - a randomized controlled trial.

Background and study aims Endoscopic removal of biliary stones has high success rates, ranging between 85 % to 95 %. Nevertheless, some stones may be challenging and different endoscopic methods have evolved. Papillary large balloon dilation after sphincterotomy is a widely used technique with success rates ranging from 68 to 90 % for stones larger than 15 mm. Cholangioscopy allows performing lithotripsy under direct biliary visualization, either by laser or electrohydraulic waves, which have similar success rate (80 % – 90 %). However, there is no study comparing these 2 techniques. Patients and methods From April 2014 to June 2016, 100 patients were enrolled and randomized in 2 groups, using a non-inferiority hypothesis: cholangioscopy + electrohydraulic lithotripsy (group 1) and endoscopic papillary large balloon dilation (group 2). The main outcome was complete stone removal. Adverse events were documented. Mechanical lithotripsy was not performed. Failure cases had a second session with crossover of the methods. Results The mean age was 56 years. 74 (75.5 %) patients were female. The initial overall complete stone removal rate was 74.5 % (77.1 % in group 1 and 72 % in group 2, P > 0.05). After second session the overall success rate achieved 90.1 %. Procedure time was significantly lower in group 2, – 25.2 min (CI95 % – 12.48 to – 37.91). There were no significant differences regarding technical success rate, radiologic exposure and adverse events. Conclusion Single-operator cholangioscopy-guided lithotripsy and papillary large balloon dilation are effective and safe approaches for removing complex biliary stones.

Endoscopic Management of Difficult Bile Duct Stones.

In 10-15% of the cases, conventional methods for removing bile duct stones by ERCP/balloon-basket extraction fail. The purpose of this review is to describe endoscopic techniques in managing these "difficult bile duct stones." Endoscopic papillary large balloon dilation with balloon extraction ± mechanical lithotripsy is the initial approach used to retrieve large bile duct stones. With advent of digital cholangioscopy, electrohydraulic and laser lithotripsy are gaining popularity. Enteroscopy-assisted or laparoscopic-assisted approaches can be used for those with gastric bypass anatomy. Difficulties in removing bile duct stones can be related to stone-related factors such as the size and location of the stone or to altered anatomy such as stricture in the bile duct or Roux-en-Y anatomy. Several endoscopy approaches and techniques have described in the recent past that have greatly enhanced our ability to remove these "difficult" bile duct stones.

The Management of Common Bile Duct Stones

Common bile duct (CBD) stone is a relatively frequent disorder with a prevalence of 10-20% in patients with gallstones. This is also associated with serious complications, including obstructive jaundice, acute suppurative cholangitis, and acute pancreatitis. Early diagnosis and prompt treatment is the most important for managing CBD stones. According to a recent meta-analysis, endoscopic ultrasonography and magnetic resonance cholangiopancreatography have high sensitivity, specificity, and accuracy for the diagnosis of CBD stones. Endoscopic ultrasonography, in particular, has been reported to have higher sensitivity between them. A suggested management algorithm for patients with symptomatic gallstones is based on whether they are at low, intermediate, or high probability of CBD stones. Single-stage laparoscopic CBD exploration and cholecystectomy is superior to endoscopic retrograde cholangiopancreatography (ERCP) plus laparoscopic cholecystectomy with respect to technical success and shorter hospital stay in high risk patients with gallstones and CBD stones, where expertise, operative time, and instruments are available. ERCP plus laparoscopic cholecystectomy is usually performed to treat patients with CBD stones and gallstones in many institutions. Patients at intermediate probability of CBD stones after initial evaluation benefit from additional biliary imaging. Patients with a low probability of CBD stones should undergo cholecystectomy without further evaluation. Endoscopic sphincterotomy and endoscopic papillary balloon dilation in ERCP are the primary methods for dilating the papilla of Vater for endoscopic removal of CBD stones. Endoscopic papillary large balloon dilation is now increasingly performed due to the usefulness in the management of giant or difficult CBD stones. Scheduled repeated ERCP may be considered in patients with high risk of recurrent CBD stones.

Nasobiliary drainage can reduce the incidence of post-ERCP pancreatitis after papillary large balloon dilation plus endoscopic biliary sphincterotomy: a randomized controlled trial

Background and aims: Post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis can be reduced following endoscopic papillary balloon dilation with the placement of an endoscopic nasobiliary drainage (ENBD) catheter. The aim of this study was to determine whether the placement of an ENBD reduces the risk of post-ERCP pancreatitis following endoscopic papillary large balloon dilation together with endoscopic biliary sphincterotomy.Methods: A total of 160 patients with bile duct stones were randomly assigned (1:1) to an ENBD group or no-ENBD group. The primary outcome of this study was the incidence of post-ERCP pancreatitis. The secondary outcome was the incidence of post-ERCP hyperamylasemia.Results: In total, 160 patients were randomized, and 155 were found to be eligible for the analysis. The two groups were similar regarding clinical and demographic factors as well as patient- and procedure-related risk factors for post-ERCP pancreatitis. Post-ERCP pancreatitis developed in 9 patients, that is, 8/77 (10.4%) of the control group and 1/78 (1.28%) of the ENBD group (p = .018; per protocol analysis). Intention to treat analysis also revealed that ENBD reduced the rate of post-ERCP pancreatitis (8/80 (10%) in the control group vs. 1/80 (1.25%) the ENBD group (p = .034)). Multivariate regression analysis identified not undergoing ENBD as an independent risk factor for post-ERCP pancreatitis (ENBD compared with no-ENBD: OR 0.087, 95% CI 0.011–0.734; p = .025).Conclusion: This study demonstrated that placement of an ENBD was effective and safe for the prevention of post-ERCP pancreatitis in patients undergoing endoscopic papillary large balloon dilation together with endoscopic biliary sphincterotomy.

Evaluation of direct peroral cholangioscopy by freehand intubation for diagnosis and therapy of biliary diseases

Objective To evaluate the feasibility and safety of direct peroral cholangioscopy (DPCS) by freehand intubation using routine straight-view endoscope for diagnosis and therapy of biliary diseases. Methods Patients with unexplained choledochal stenosis and choledocholithiasis underwent standard ERCP. Native papilla was dilated using endoscopic papillary large balloon dilation (EPLBD) according to the size of papilla and the diameter of common bile duct. DPCS was performed using routine straight-view endoscope, and biopsy or laser lithotripsy was performed according to imaging of DPCS. General data of patients, procedure of ERCP, diagnosis of DPCS, and complications were recorded. Serum amylase after 2 hours and 24 hours, total bilirubin, direct bilirubin, leukocyte count, neutrophilic granulocyte percentage, and C-reactive protein were measured. Results A total of 15 patients underwent DPCS, including 5 cases of huge common bile duct stones and 10 cases of common bile duct stricture.The diameter of common bile duct ranged from 1.5 cm to 2.5 cm. Single EPLBD was required in 3 cases, endoscopic sphincteropapillotomy and EPLBD was required in 12 cases to facilitate DPCS.DPCS was successfully completed in 14 cases, including 11 cases in distal common bile duct, 3 cases in proximal common bile duct. Among the 14 cases, 4 cases used ordinary gastroscope, and 10 cases used ultrathin gastroscope. Laser lithotripsy was successfully completed in 4 choledocholithiasis patients. DPCS was successfully completed in 9 patients of common bile duct stenosis. The reasons of stenosis included 5 calculi, 2 normal, 1 scar and 2 adenoma. There were 1 case of cholangitis and 4 cases of hyperamylasemia after operation.No procedure related death occurred. Conclusion Freehand DPCS using ordinary gastroscope or ultrathin gastroscope is feasible and safe, and may be clinically useful for diagnosis and therapy of unexplained choledocholithiasis and common bile duct stenosis. Key words: Choledocholithiasis; Cholangiopancreatography, endoscopic retrograde; Lithotripsy, laser; Direct peroral cholangioscopy

Predictors for bile duct stone recurrence after endoscopic extraction for naïve major duodenal papilla: A cohort study.

BackgroundPredictors for bile duct stone recurrence after endoscopic stone extraction have not yet been clearly defined and a study investigating naïve major duodenal papilla is warranted because studies focusing only on naïve major duodenal papilla are rare. The aim of this study was to observe the long-term outcomes of endoscopic bile duct stone extraction for naïve major duodenal papilla and to assess the predictors for recurrence.MethodsThis was a retrospective cohort study that consisted of 384 patients with naïve papilla who underwent initial endoscopic bile duct stone extraction. Patients were followed up in outpatient department subsequent to complete stone clearance. Recurrence was defined as symptomatic repeated stone formation observed at least three months after the procedure. Stone recurrence, predictors of recurrence, and the recurrence rate, depending on each endoscopic treatment for major duodenal papilla, were examined.ResultsIn this study, 34 patients (8.9%) developed stone recurrence. The median time to recurrence was 439 days. Periampullary diverticulum and multiple stones were strong predictors of bile duct stone recurrence (RR, 5.065; 95% CI, 2.435–10.539 and RR: 2.4401; 95% CI: 1.0946–5.4396, respectively). The above two factors were independent predictors of stone recurrence as per logistic regression analysis adjusted for confounders (Periampullary diverticulum: OR, 7.768; 95% CI, 3.27–18.471; multiple stones: OR, 4.144; 95% CI, 1.33–12.915). No recurrence was observed after endoscopic papillary large balloon dilatation (0/20), whereas recurrence was observed in 7 patients after endoscopic papillary balloon dilatation (7/45) and in 27 patients after endoscopic sphincterotomy (27/319). However, these differences were not statistically significant (p = 0.105).ConclusionsWe determined that the presence of periampullary diverticulum and multiple stones are strong predictors for recurrence after endoscopic stone extraction. Moreover, endoscopic papillary large balloon dilatation tended to be correlated with non-recurrence of bile duct stone.

Endoscopic Papillary Large Balloon Dilation Versus Endoscopic Sphincterotomy for Retrieval of Large Choledocholithiasis: A Prospective Randomized Trial

Endoscopic sphincterotomy (ES) is the standard technique for common bile duct (CBD) stone removal. Recently, endoscopic papillary large balloon dilation (EPLBD) has been shown to be a safe and effective technique for the removal of large CBD stone. The aim of this study was to determine the therapeutic outcomes and safety of EPLBD compared with ES for large CBD stone extraction. One hundred twenty-four patients with large bile duct stones were randomized into two groups, the first group included 61 patients subjected to EPLBD and the second group included 63 patients who underwent ES. We compared the success rate of stone removal, frequency of mechanical lithotripsy requirement, morbidity, and mortality. Baseline characteristics were not significantly different. The overall ductal clearance rate was ultimately similar between the EPLBD group (96.7%) and the ES group (93.7%) (P = .53), the one session ductal clearance rate was significantly different (86.9% versus 71.4%; P = .01). Requirement of mechanical lithotripsy was significantly different between the EPLBD and ES group (9.8% versus 17.5%, P = .04). There were no differences in complication rates between the EPLBD and ES group; pancreatitis, 4.9% versus 6.3%; minor hemorrhage, 1.6% versus 6.3%; acute cholangitis, 3.3% versus 1.9%; and recurrent stones, 3.3% versus 3.2%. The therapeutic outcomes of EPLBD for removal of large bile duct stones are better than those of ES with comparable complication rate. EPLBD is also recommended for removal of large CBD stone in patients with an underlying coagulopathy or need for anticoagulation following endoscopic retrograde cholangiopancreaticography.

Comparison of Endoscopic Papillary Large Balloon Dilation and Endoscopic Sphincterotomy for Retrieval of Choledocholithiasis

Background: Endoscopic sphincterotomy (EST) combined with balloon catheters and/or baskets are the routine endoscopic techniques for stone extraction in the great majority of patients. Whereas large common bile duct (CBD) stones are treated conventionally with mechanical lithotripsy, large balloon papillary dilation after endoscopic sphincterotomy (ELPBD) represents the onset of an era in large CBD stone extraction and the management of “impaction”. That is because it seems effective, inexpensive, less traumatic, safe and easy method that does not require sophisticated apparatus and can be performed widely by skillful endoscopists. Studies comparing the efficacy and safety of EPLBD with EST have reported mixed outcomes. The aim of the study to compare the success and complications rates between endoscopic papillary balloon dilation and endoscopic sphincterotomy for enlargement of papillary opening during endoscopic removal of common bile duct stones. Methods: Randomized prospective comparative study was conducted on seventy four patients with CBD stone(s), subjective to therapeutic ERCP procedures for endoscopic extraction of common CBD(s). The enrolled patients were randomly divided into two groups according to the maneuver for dilate the papillary orifice into: Group I: Thirty one patients underwent EPLBD technique combined with balloon catheters and/or baskets for stone extraction. Group II: Forty three patients underwent EST combined with balloon catheters and/or baskets, which is considered as conventional endoscopic technique for stone extraction in the great majority of patients. Results: Complete extraction CBD stones among the patients of group1; EPLBD was effective for clearance of (92.5%) of CBD stones in patients with the stone sized 1cm, (overall clearance rate=87%). Overall adverse effects of patients of group1 was (29%) as mild self-limiting post ERCP pain occurred in (9.6%) and mild intra- procedure bleeding occurred in (9.6%), whereas more serious complication as melena which occurred in (3.2%), and mild pancreatitis occurred in (6.4%). Whereas complete CBD stones clearance among the patients of group 2; EST was effective in (96%) of patients with the stone sized 1cm, (overall clearance rate=79%). Overall adverse effects of patients of group 2 was (18.5%) as mild self-limiting post ERCP pain occurred in (7%) and mild intra-procedure bleeding occurred in (4.6%), whereas more serious complications as mild pancreatitis developed in (4.6%), and post ERCP cholangitis in (2.3%). The comparison between the two groups regarding the extraction of CBD stones revealed combination of papillary large balloon dilation after EST is not required in patients whose the CBD stone size 1cm among the group 1 was (83%) which better than among the group 2 which was (56%) with nearly statistical difference (P value=0.07). Conclusion: Conventional EST is an effective method for removal of common bile duct stones 1cm which is difficult to be extracted by conventional sphincterotomy and extraction devices. Endoscopic papillary large balloon dilation is an adjunctive tool to endoscopic sphincterotomy for removing large or difficult CBD stones.

Transpapillary passage of a giant bile duct stone after endoscopic papillary large balloon dilation and short-term stenting

Transpapillary passage of a giant bile duct stone after endoscopic papillary large balloon dilation and short-term stenting

What Is the Value of the Learning Curve in Endoscopic Balloon Dilatation of the Major Papilla?

Introduction Endoscopic papillary large balloon dilatation (EPLBD) is an alternative for the treatment of common bile duct (CBD) stones. Existing evidence of factors associated with its outcomes is contradictory. Objective To identify predictors (including the experience of an endoscopist) of success and adverse events in EPLBD. Methods We reviewed the first 200 EPLBD with endoscopic sphincterotomy (EST) performed at our center. Demographic, clinical, and anatomic variables were studied, as well as the performance characteristics, correlating them with individual and group experience. Results Global success was obtained in 87% of cases, and adverse events occurred in 16% of cases. Success was associated with stone size, CBD diameter, and the need to perform mechanical lithotripsy (ML). Despite that adverse events were not univariately associated with any factor, severe adverse events were more likely to occur in stones > 13.5 mm. Multivariate analysis which disclosed success was higher when ML was not required and stones were < 13.5 mm. It also showed that no factor was associated with adverse events or their severity. No differences were found on success or adverse events that could be directly related to experience. Conclusions Success of EPLBD-EST is higher in stones < 13.5 mm and when ML is not required. Experience does not appear to play a major role.

Arterial bleeding after endoscopic papillary large balloon dilation without endoscopic sphincterotomy for bile duct stones successfully treated by endoscopic hemostatsis

Arterial bleeding after endoscopic papillary large balloon dilation without endoscopic sphincterotomy for bile duct stones successfully treated by endoscopic hemostatsis

Recurrence of bile duct stones after endoscopic papillary large balloon dilation combined with limited sphincterotomy

Objective To evaluate the long term recurrence rate of common bile duct stones after endoscopic papillary large balloon dilation(EPLBD) combined with limited sphincterotomy. Methods A total of 200 patients with large common bile duct stones (diameter>1.00 cm) were included and randomized into two groups. One group was treated with EST alone, while the other group was treated with EST and EPLBD. The procedure time, complete stone removal rate during the first session and the usage rate of mechanical lithotripsy were analyzed. The recurrence rate and time of common bile duct stones were observed after follow-up of 36 months. Results Compared with EST group, EST+ EPLBD group showed a shorter procedure time (33.6±13.6 min VS 41.7±19.4 min, P=0.018); a higher complete stone removal rate during the first session[96%(96/100) VS 84%(84/100), P=0.010] and a lower usage rate of mechanical lithotripsy[6%(6/100) VS 36%(36/100), P<0.001]. But the recurrence rate of common bile duct stones in EPLBD+ EST group did not significantly decrease[18% (18/100) VS 23% (23/100), P=0.381], and the recurrence time was similar (24.6± 2.27 months VS 25.5± 2.11 months, P=0.741). Conclusion Endoscopic papillary large-balloon dilation combined with limited endoscopic sphincterotomy has some advantages in the procedure time, complete stone removal rate during the first session and the usage rate of mechanical lithotripsy, but it shows no advantage in long-term recurrence rate and time. Key words: Choledocholithiasis; Sphincterotomy, endoscopic; Endoscopic balloon dilation

Impact of endoscopic papillary large-balloon dilation on sphincter of Oddi function: a prospective randomized study

Endoscopic papillary balloon dilation (≤8mm in diameter) preserves sphincter of Oddi (SO) function. However, it is still unknown whether papillary function is preserved after endoscopic papillary large-balloon dilation (EPLBD,≥12mm in diameter). We investigated SO function after EPLBD with or without endoscopic sphincterotomy (EST) by endoscopic manometry, up to 1 year after the procedure. This was a prospective randomized study involving patients with bile duct stones≥12mm. Eighty-six patients who met the inclusion criteria were assigned randomly to either EPLBD alone or EST with EPLBD, and endoscopic manometric studies were performed. The primary outcome was comparison of the manometric data between the 2 groups and within each group both 1 week and 1 year after the procedure. One week after EPLBD alone and EST with EPLBD, the basal pressure of SO dropped from 30.4 (8.2) to 6.4 (8.4)mm Hg (P< .001) and 29.5 (18.9) to 2.9 (3.6)mm Hg (P< .001), respectively. SO function was not recovered at 1 year; the manometric measurements were similar to those taken at the 1-week time point in both groups. Similar outcomes were obtained in patients with EPLBD alone compared with those with EST and EPLBD, including the initial stone clearance rate (95.2% vs 97.7%, P= .612), the frequency of mechanical lithotripsy (21.4% vs 13.6%), and overall adverse events (11.9% vs 13.6%, P= 1.0) including the rate of pancreatitis after the procedure (7.1% vs 11.4%, P= .714). During an overall median follow-up of 17.8 months, the recurrence rate of bile duct stones was 16.7% in patients who underwent EPLBD alone and 15.9% in patients who underwent EST with EPLBD (P= .924). Both EPLBD alone and EST+ EPLBD resulted in persistent and comparable loss of SO function after 1 year. EPLBD alone has similar efficacy and safety to those of EST with EPLBD with respect to removal of large stones.

Feasibility of Endoscopic Papillary Large Balloon Dilation in Patients with Difficult Bile Duct Stones without Dilatation of the Lower Part of the Extrahepatic Bile Duct.

Background/AimsThere is no consensus for using endoscopic papillary large balloon dilation (EPLBD) in patients without dilatation of the lower part of the bile duct (DLBD). We evaluated the feasibility and safety of EPLBD for the removal of difficult bile duct stones (diameter ≥10 mm) in patients without DLBD.MethodsWe retrospectively reviewed the records of 209 patients who underwent EPLBD for the removal of bile duct stones from October 2009 to July 2014. Primary outcomes were the clearance rate and additional mechanical lithotripsy. Secondary outcomes were the incidence of complications and recurrence rate.ResultsFifty-seven patients had DLBD (27.3%), and 152 did not have DLBD (72.7%). There were no significant differences in the overall success rate or the use of mechanical lithotripsy. Success rate during the first session and procedure time were better in the DLBD than the without-DLBD group (75.7% vs 66.7%, 48.1±23.0 minutes vs 58.4±31.7 minutes, respectively). As for complications, there were no significant differences in the incidence of pancreatitis, perforation or bleeding after endoscopic retrograde cholangiopancreatography. The recurrence rate did not differ significantly between the two groups.ConclusionsEPLBD is a useful and safe method for common bile duct stone removal in patients without DLBD.

Long-term recurrence of bile duct stones after endoscopic papillary large balloon dilation with sphincterotomy: 4-year extended follow-up of a randomized trial.

Endoscopic papillary large balloon dilation with biliary sphincterotomy (EPLBD+EBS) is safe and effective in patients with large common bile duct (CBD) stones. However, data on long-term outcomes after EPLBD+EBS remain limited. We sought to prospectively evaluate the long-term recurrence of CBD stones after EPLBD+EBS and to identify the associated factors. We conducted an extended follow-up of a previous randomized trial (2009-2011) comparing the outcomes of 30- versus 60-s large balloon dilation. A total of 106 trial participants undergoing successful CBD stone clearance by EPLBD+EBS were prospectively followed up for up to 4years (range 19-48months). Various risk factors were analysed to assess predictors of long-term recurrence of stones. Recurrent CBD stones appeared in 8/106 (7.5%) patients during a mean follow-up of 30.5±5.5months. The mean diameter of CBD was significantly higher in the recurrence versus non-recurrence group (2.0±4.9 vs 1.6±0.9cm, p=0.008). Multivariate analysis revealed that CBD diameter was the only predictor significantly associated with the long-term recurrence of stones (odds ratio 1.2, p=0.01). EPLBD+EBS is associated with a low rate of long-term CBD stone recurrence. However, the risk is significantly higher in patients with a more dilated CBD.

Endoscopic Papillary Large Balloon Dilatation Without Sphincterotomy for the Treatment of Large Common Bile Duct Stone: Long-Term Outcomes at a Single Center.

Endoscopic papillary large balloon dilatation (EPLBD) without endoscopic sphincterotomy (EST) is an accepted, simplified endoscopic technique for large common bile duct (CBD) stone removal. However, little is known about the long-term outcomes of this technique. The purpose of this study was to evaluate the long-term outcomes of EPLBD without EST for the treatment of large CBD stones. This retrospective study of EPLBD without EST for a large CBD stone was conducted between June 2005 and October 2010. A total of 128 patients with a large CBD stone were included. The primary outcome measurement was complete CBD stone removal after EPLBD. Clinical data obtained from medical records were analyzed. The overall complete stone removal rate was 94.5%. Mechanical lithotripsy was needed in 18 (14.1%) patients. Post-procedural pancreatitis and asymptomatic hyperamylasemia occurred in 1 (0.8%) and 11 (8.6%) patients, respectively. One (0.8%) patient experienced minor bleeding. The rate of stone recurrence was 13.1%, and median time to stone recurrence was 600days (range 144-2284days). Over a half (64.3%) of stone recurrences occurred during the 2years following stone removal. Recurrence tended to be more frequent in patients with a large CBD diameter and in patients requiring multiple endoscopic sessions for complete CBD stone retrieval. EPLBD without EST may be safe and effective in patients with a large bile duct stone.

Tu1602 Feasibility of Endoscopic Papillary Large Balloon Dilatation With Double-Balloon Endoscopic Retrograde Cholangiography for Patients With Choleductolithiasis and Surgically Altered Anatomy

Recently, endoscopic papillary large balloon dilatation (EPLBD, balloon size: 12–20 mm) has been used to treat large bile duct stones. Double-balloon endoscopic retrograde cholangiography (DB-ERC) has been used for patients with choleductolithiasis who have surgically altered upper gastrointestinal tracts, whereas classical endoscopic papillary balloon dilatation (EPBD, balloon size: 8mm) has been used with DB-ERC in the past. We recently introduced EPLBD with DB-ERC in patients with surgically altered anatomy. We evaluated the feasibility, safety, and efficacy of EPLBD compared to EPBD with DB-ERC.

Small endoscopic sphincterotomy combined with endoscopic papillary large-balloon dilation in the treatment of patients with large bile duct stones

Background To compare the effectiveness and safety of the combination of endoscopic papillary large-balloon dilation (EPLBD) and small endoscopic sphincterotomy (SEST) with either EST or EPLBD alone in the treatment of large bile duct stones.