Large Common Bile Duct Stones Research Articles

Extraction of Common Bile Duct Stones Refractory to Mechanical Lithotripsy Using Extracorporeal Shock Wave Lithotripsy

The standard treatment for choledocholithiasis is to remove the stones by performing endoscopic retrograde cholangiopancreatography (ERCP). With various techniques such as basket extraction, balloon catheter extraction, mechanical lithotripsy, followed by endoscopic papillary sphincterotomy or endoscopic papillary balloon dilatation, the success rate of stone extraction is known to be over 90%. However, stone extraction can fail in cases with large common bile duct stones or biliary stricture. We report a case of impacted choledocholithiasis after conventional ERCP and mechanical lithotripsy treated with extracorporeal shock wave lithotripsy.

Holmium Laser Lithotripsy in the Management of Difficult Biliary and Cystic Ductal Stones – A Case Series

Abstract Choledocholithiasis or common bile duct stone (CBDS) presents a unique challenge in the management of biliary stones. The clinical presentation of CBDS varies from asymptomatic CBDS, detected during the evaluation of gallstone disease to sinister presentation, like severe biliary pancreatitis. Asymptomatic liver function test abnormality, biliary colic, dilated common bile duct (CBD) on sonography for pain abdomen, and cholangitis are the part of the spectrum. Based on clinical suspicion and aided by laboratory parameters, the diagnosis is confirmed by modalities such as ultrasonography or magnetic resonance cholangiopancreatography or by endoscopic ultrasound. Endoscopic radiological cholangiopancreatography (ERCP) has evolved as a standard of care over the decades for the management of CBDS and surgical exploration of CBD is rarely resorted. ERCP is followed by laparoscopic cholecystectomy as a definitive treatment to prevent recurrence of CBDS. Multiple factors play a role in the successful extraction of CBDS. Two broad considerations are the size of stone and bilio-duodenal anatomy. Multiple studies have noted that stone size larger than 15 mm requires fragmentation for successful extraction. Mechanical lithotripsy has been cornerstone for the management of such cases. Besides size of stone, morphology and number of stones, narrow CBD (distal to stone), duodenal diverticulum and altered anatomy due to gastroduodenal surgeries pose a challenge in stone extraction and are collectively called difficult CBDS. Multiple modalities notably extracorporeal shortwave lithotripsy, holmium laser (Ho laser) lithotripsy, and electrohydraulic lithotripsy (EHL) have been studied for the fragmentation of large CBDS. Innovation in cholangioscopy and wider availability of peroral single-operator cholangioscope has brought EHL and Ho laser lithotripsy (LL) at forefront of management of difficult CBD stones. We share the experience of Ho LL for CBDS at a tertiary care hospital in Western India. The data of four patients, successfully managed with single-operator cholangioscopy (SoC)-guided Ho LL for indications ranging from large CBDS to residual large cystic duct stump stone has been discussed. These cases emphasize wider clinical application of SoC-guided Ho-LL beyond the size of the stone. Ho LL has revolutionized the management of difficult biliary stone. The major limitation is cost of care and availability of expertise.

Laparoscopic Common Bile Duct Exploration for Multiple Large Common Bile Duct Stones: A Case Report with Review of Literature

Endoscopic retrograde cholangio pancreatography (ERCP) followed by laparoscopic cholecystectomy (LC) in 2 different sessions, is the widely followed standard sequence of surgical procedures for concurrent gall bladder and common bile duct (CBD) stone disease, across the world. However, being highly technical, skillful and technology dependant, ERCP, sometimes, does not succeed even in the best of hands. This can happen due to abnormal local anatomy (eg. Previous Billroth II gastrectomy, previous surgical scars which distort the duodenum etc.) and unfriendly stone morphology such as a very large stone or a large number of stones. Failure to extract/retrieve bile duct stones at ERCP is an indication for CBD exploration (open or laparoscopic) at surgery. Herein, we present one such case of a 67 year old woman who had previously undergone surgery – laparoscopic cholecystectomy for gall stone disease 3 years back. She presented to us with a common bile duct loaded with multiple large stones. Inspite of undergoing ERCP (2 attempts over 48 hours), a common bile duct access could not be achieved endoscopically, thereby rendering endotherapy unsuccessful. She then underwent a successful totally laparoscopic CBD exploration, using standard laparoscopy instruments, some endoscopy accessories like endo-balloon & dormia basket and intraoperative fluoroscopy.

A multidisciplinary approach: removal of large common bile duct stones in a patient with Roux-en-Y gastric bypass not amenable to EDGE procedure and high surgical risk

A multidisciplinary approach: removal of large common bile duct stones in a patient with Roux-en-Y gastric bypass not amenable to EDGE procedure and high surgical risk

OGBN O09V Multi-modal Approach with Fluorescence Imaging, Intraoperative Ultrasound and Laser Lithotripsy in the Laparoscopic Management of Complex Large Bile Duct Stones

Abstract Background Choledocholithiasis is a common condition with various presentations. There are several approaches through which this can be managed. This presentation aims to explain novel techniques and various modalities in managing complex bile duct stones successfully with minimal invasive approach. Methods This video presentation depicts the procedure performed for large CBD stones with the use of indocyanine green (ICG) and intraoperative ultrasound (IOUS). The patient is a 61 year old gentleman presented with abdominal discomfort and deranged liver functions. Cross sectional imaging showed 2 large CBD calculi and attempt at endoscopic retrograde cholangio-pancreatigoraphy (ERCP) failed due to large impacted stones. Decision was made to proceed to single stage laparoscopic cholecystectomy and common bile duct exploration with use of ICG, IOUS and laser lithotripsy to achieve successful clearance of CBD. Results At laparoscopy, the CBD and common hepatic artery were identified with ICG and IOUS. A vertical choledochotomy was performed and choledochoscopy undertaken. Attempts to retrieve the stone with extraction basket were not successful. Laser lithotripsy was used to break the stones into smaller fragments which were subsequently retrieved using atraumatic graspers and extraction wire. Post operative period was uneventful and the patient was discharged home on day 2. Face to face follow-up at 6 weeks confirmed good recovery. Conclusions Laparoscopic management of complex CBD stones is challenging. Despite advances in endoscopy intervention, the role of surgery is irrefutable. Advanced laparoscopic skills and experience in bile duct exploration with advanced minimally invasive instruments and equipment are critical to achieve optimal patient outcomes, and mitigated the chances of conversion to open surgery which its associated morbidity. This presentation demonstrates a safe technique while working in the hostile area of the inflamed hepatocystic triangle and an alternative method in the retrieval of large common bile duct stones following failed ERCP.

Endoscopic papillary large balloon dilation with wide sphincterotomy and brief balloon expansion is safe and leads rarely in recurrence in large common bile duct stones

Endoscopic papillary large balloon dilation with wide sphincterotomy and brief balloon expansion is safe and leads rarely in recurrence in large common bile duct stones

Large common bile duct stones in high-risk elderly patients: Immediate endoscopic stone removal or elective stone removal? A single-center retrospective study

Background and objectiveFor high-risk elderly patients with chronic diseases, endoscopic stone removal for large common bile duct stones is associated with a high risk of adverse events and incomplete stone removal. The aim of this study was to investigate whether the treatment strategy of short-term biliary plastic stent placement followed by elective endoscopic stone removal is more effective and safer than immediate endoscopic stone removal.MethodsThe data of 262 high-risk elderly patients who received endoscopic retrograde cholangiopancreatography (ERCP) for large common bile duct (CBD) stones from 2017 to 2022 were retrospectively analyzed. The patients were divided into group A (immediate stone removal) and group B (stent drainage + elective stone removal). The baseline data of the 2 groups were matched 1:1 by propensity score matching. The stone clearance rate, ERCP procedure time, total hospital stay, and procedure-related adverse events were compared between the matched groups. In group B, stone size before and after stent placement, hospital stay, procedure time and adverse events of two ERCPs were compared.ResultsA total of 57 pairs of patients were successfully matched between the 2 groups. The stone clearance rate in group B was higher than that in group A (89.5% vs. 75.3, P = 0.049). The total hospital stay in group B was longer than that in group A (11.86 ± 3.912 d vs. 19.14 ± 3.176 d, P<0.001). The total adverse event rate in group A was higher than that in group B (29.8% vs. 12.3%, P = 0.005). The incidence of cholangitis/cholecystitis after ERCP was significantly higher in group A than in group B (7.0% vs. 0.9% P = 0.029). There was no significant difference in the incidence of post-ERCP pancreatitis, bleeding, pneumonia, and cardio-cerebrovascular events between the 2 groups. There were no perforation cases in either group. After plastic biliary stent placement in group B, the stone size was significantly smaller than before stent placement (1.59 ± 0.544 cm vs. 1.95 ± 0.543 cm, P < 0.001), and there was no significant difference in the total adverse event incidence between the two ERCP procedures (18.8% vs. 10.9%, P = 0.214).ConclusionFor high-risk elderly patients with large CBD stones, the treatment strategy involving temporary placement of plastic stent and elective endoscopic stone removal is safer and more effective than immediate stone removal.

Cholangioscopic inspection immediately after endoscopic retrograde cholangiopancreatography for large common bile duct stone may be beneficial to discover potential cholangiocarcinoma resulting from choledocholithiasis.

Cholangioscopic inspection immediately after endoscopic retrograde cholangiopancreatography for large common bile duct stone may be beneficial to discover potential cholangiocarcinoma resulting from choledocholithiasis.

Radiation-free digital cholangioscopy-guided removal of bile duct foreign body and holmium laser lithotripsy for large common bile duct stones.

Digital cholangioscopy (SpyGlass; Boston Scientific, Marlborough, Massachusetts, USA) allows direct visualization of the biliary system for therapeutic interventions [1]. This is a report of cholangioscopy-guided removal of a biliary plastic stent and holmium laser lithotripsy for large common bile duct (CBD) stones.

Outcomes of endoscopic papillary large balloon dilatation in comparison to mechanical lithotripsy for large common bile duct stone

Background: The management of common bile duct stone (CBDS) has changed drastically over the past two decades, as open surgery has been supplanted by per-oral endoscopic procedures. Currently, therapeutic endoscopic retrograde cholangiopancreatography (ERCP) is the standard worldwide. After performing an endoscopic biliary sphincterotomy (EBST), endoscopic therapy entails CBDS extraction using conventional procedures. Lithotripsy is an endoscopic procedure used to remove CBDS that are too large to be extracted using conventional techniques.Aim: The aim of the present work is to compare the results of endoscopic large balloon dilatation and mechanical lithotripsy for large CBDS.Subjects and Methods: This prospective cohort study was conducted on 60 cases undergoing endoscopic retrograde cholangial pancreatography for large CBDS who were referred to out-case's clinic and in-case's wards of Gastroenterology, Hepatology and Endoscopy unit of Internal Medicine Department at Tanta University Hospitals December 2019 to February 2021. Cases were divided into two equal groups. Group I included cases undergoing endoscopic papillary large balloon dilatation (EPLBD) and Group II included cases undergoing mechanical lithotripsy (ML).Results: Success of CBDS extraction, Hb, PLT, TLC, albumin, PA, ALT, AST, creatinine and urea and CBDS parameters (diameter, CBDS size, CBDS number) after ERCP were insignificantly different between both groups. Total serum bilirubin, direct serum bilirubin and, Alkaline phosphatase after ERCP were significantly lower in EPLBD. However, Amylase and lipase were significantly higher in EPLBD.Conclusion: Despite that the endoscopic large balloon dilatation caused significantly higher pancreatitis, it showed lower TSB, DSB and ALP. However, both techniques showed no difference regarding the success of CBDS extraction and laboratory investigations.

Bile Duct Stone Size May Influence the Efficacy of Endoscopic Sphincterotomy With or Without Large-Balloon Dilation: A Meta-Analysis.

Purpose: Endoscopic sphincterotomy (EPT) combined with endoscopic papillary large balloon dilatation (EPBD) are used to remove large common bile duct (CBD) stones. This meta-analysis compared the efficacy and safety of EPT+EPBD versus EPT alone in the removal of stones based on stone size. Materials and Methods: Twenty-two studies (11 randomized control trials [RCTs] and 11 non-RCTs) were identified and reviewed based on searches of Embase, PubMed, and Web of Science. CBD stone's size was measured with reference to diameter of the duodenoscope (13 mm) and size of the large dilatation balloon (17 mm) seen on cholangiogram. The stone clearance rate, required mechanical lithotripsy (ML), procedure time, and pancreatitis were compared according to the mean stone size, and further divided into Groups A (small) 10-13 mm, B (medium) 13-17 mm, and C (large) >17 mm. Results: Subgroup analysis according to CBD stone size showed EPT + EPBD had a significantly better initial stone clearance rate than EPT in Groups B (odds ratio [OR] = 2.39, 95% confidence interval [CI]: 1.20-4.77) and C (OR = 3.05, 95% CI: 1.86-5.03), but not for Group A (OR = 1.41, 95% CI: 0.90-2.21). EPT+EPBD also required significantly less ML than EPT in Groups B (OR = 0.34, 95% CI: 0.15-0.77) and C (OR = 0.31, 95% CI: 0.13-0.73). EPT+EPBD had significantly shorter procedure time than EPT in Group B (standardized mean difference = -1.20, 95% CI: -2.08 to 0.32). In meta-regression analysis, Group B had a better OR in initial stone clearance rate and less ML usage rate correlation with the size of CBD stone, but not for Group C with larger stones. Conclusions: EPT+EPBD had a significantly better initial stone clearance rate, and required less ML with shorter procedure time than EPT for removing medium-sized CBD stones, but the efficacy was limited to large CBD stones. The study protocol and trial registration had been registered in PROSPERO (Registration No. CRD42020171689).

Endoscopic sphincterotomy vs papillary large balloon dilation vs combination modalities for large common bile duct stones: a network meta-analysis.

Background and study aims The optimal technique for removal of large common bile duct (CBD) stones (≥ 10 mm) during endoscopic retrograde cholangiopancreatography (ERCP) remains unclear. We aimed to perform a comparative analysis between different endoscopic techniques. Methods Adhering to PRISMA guidelines, a stringent search of the following databases through January 12, 2021, were undertaken: PubMed/Medline, Embase, Web of Science, and Cochrane. Randomized controlled trials comparing the following endoscopic techniques were included: (1) Endoscopic sphincterotomy (EST); (2) Endoscopic papillary large balloon dilation (EPLBD); and (3) EST plus large balloon dilation (ESLBD). Stone clearance rate (SCR) on index ERCP was the primary outcome/endpoint. Need for mechanical lithotripsy (ML) and adverse events were also evaluated as secondary endpoint. Random effects model and frequentist approach were used for statistical analysis. Results A total of 16 studies with 2545 patients (1009 in EST group, 588 in EPLBD group, and 948 patients in ESLBD group) were included. The SCR was significantly higher in ESLBD compared to EST risk ratio [RR]: 1.11, [confidence interval] CI: 1.00-1.24). Lower need for ML was noted for ESLBD (RR: 0.48, CI: 0.31-0.74) and EPLBD (RR: 0.58, CI: 0.34-0.98) compared to EST. All other outcomes including bleeding, perforation, post-ERCP pancreatitis, stone recurrence, cholecystitis, cholangitis, and mortality did not show significant difference between the three groups. Based on network ranking, ESLBD was superior in terms of SCR as well as lower need for ML and adverse events (AEs). Conclusions Based on network meta-analysis, ESLBD seems to be superior with higher SCR and lower need for ML and AEs for large CBD stones.

National Survey Regarding the Management of Difficult Bile Duct Stones in South Korea.

This study aimed to investigate the patterns of preferred endoscopic procedure types and techniques for managing difficult common bile duct (CBD) stones in South Korea. The Committee of Policy and Quality Management of Korean Pancreatobiliary Association (KPBA) conducted a survey containing 19 questions. Both paper and online surveys were carried out; with the paper survey being conducted during the 2019 Annual Congress of KPBA and the online survey being conducted through Google Forms from April 2020 to February 2021. The response rate was approximately 41.3% (86/208). Sixty-two (73.0%) worked at tertiary hospitals or academic medical centers, and 60 (69.7%) had more than 5 years of endoscopic retrograde cholangiopancreatography experience. The preferred size criteria for large CBD stones were 15 mm (40.6%), 20 mm (31.3%), and 30 mm (4.6%). For managing of large CBD stones, endoscopic papillary large balloon dilation after endoscopic sphincterotomy was the most preferred technique (74.4%). When performing procedures in those with bleeding diathesis, 64 (74.4%) respondents favored endoscopic papillary balloon dilation (EPBD) alone or EPBD with small endoscopic sphincterotomy. Fifty-five respondents (63.9%) preferred the doubleguidewire technique when faced with difficult bile duct cannulation in patients with periampullary diverticulum. In surgically altered anatomies, cap-fitted forward viewing endoscopy (76.7%) and percutaneous transhepatic cholangioscopy (48.8%) were the preferred techniques for Billroth-II anastomosis and total gastrectomy with Roux-en-Y anastomosis, respectively. Most respondents showed unifying trends for the management of difficult CBD stones. The current practice patterns could be used as basic data for clinical quality improvements in the management of difficult CBD stones.

Long-term outcomes of endoscopic papillary large-balloon dilation (12–15 mm) with or without limited sphincterotomy for removal of bile duct stones

BackgroundLimited endoscopic sphincterotomy with large balloon dilation (ES-LBD) and endoscopic papillary large-balloon dilation (EPLBD) have been proven safe and effective for removal of bile duct stones. However, the long-term outcomes are not clear. The aim of this study was to assess the long-term outcomes of EPLBD (12–15 mm) with or without limited sphincterotomy for removal of common bile duct (CBD) stones. MethodsPatients with EPLBD or ES-LBD referred for the removal of bile-duct stones between June 2008 and August 2020 were retrospectively reviewed. Complete stone clearance, endoscopic retrograde cholangiopancreatography (ERCP)-related adverse events, and late biliary complications during long-term follow-up were analyzed. ResultsBasic patient characteristics were not significantly different between the groups that underwent EPLBD (n = 168) and ES-LBD (n = 57). EPLBD compared with ES-LBD resulted in similar outcomes in terms of overall successful stone removal (99.4% vs. 100%, P = 1.00) and ERCP-related adverse events (7.7% vs. 5.3%, P = 0.77). The mean duration of the follow-up were 113.6 months and 106.7 months for patients with EPLBD and ES-LBD, respectively (P = 0.13). There was no significant difference between EPLBD and ES-LBD in the incidence of stone recurrence [20 (11.9%) vs. 9 (15.8%); P = 0.49]. Multivariate analysis showed that a diameter of CBD ≥ 15 mm (OR = 3.001; 95% CI: 1.357–6.640; P = 0.007) was an independent risk factor for stone recurrence. ConclusionsThe application of a large balloon (12–15 mm) via EPLBD is an effective and safe alternative to ES-LBD for extraction of large CBD stones. Endoscopic sphincterotomy prior to EPLBD may be unnecessary. A diameter of CBD ≥ 15 mm is a risk factor of stone recurrence.

Laparoscopic Common Bile Duct Clearance, is It Feasible and Safe After Failed Endoscopic Retrograde Cholangiopancreatography?

Introduction: Concomitant gallstones and common bile duct (CBD) stones is a common problem, and there is still no consensus on the best approach in the management. Options include preoperative endoscopic retrograde cholangiopancreatography (ERCP), Laparoscopic cholecystectomy (LC) with CBD exploration, and LC with postoperative ERCP. Each option has its own limitations and complications. In this article, we assessed the feasibility of laparoscopic surgical clearance of the CBD after a failed ERCP, reasons for failure of endoscopic clearance in our cohort. We will discuss the management options after ERCP failure, the challenges, and the outcomes. Materials and Methods: We retrospectively reviewed all the cases of laparoscopic common bile duct exploration (LCBDE) performed in our hospital between April 2006 and January 2019. Two hundred cases were performed, 178 cases as a primary procedure while 22 were performed as a secondary procedure after failed ERCP. We have previously published data on the case series (PMID 33140155) and here explored the cases performed after failed ERCP as a secondary procedure. We analyzed demographics of patients, preoperative investigations, ERCP trials, and reasons for ERCP failure, operative approach, duration of operation, conversion rate, complications, and outcomes. Results: Twenty-two patients underwent a laparoscopic CBD clearance after failed ERCP. Sixteen of these were in the first 5 years of the study. Multiple attempts of ERCP were made in 7 patients (31.8%) and a single attempt in 15 patients. In 8 patients (32%), the duct was not accessible (failed cannulation) due to a variety of reasons. Nine patients had impacted stones larger than 1 cm, 4 patients had Mirrizi syndrome with concomitant large CBD stones, and 1 patient failed endoscopic clearance because of the large number of stones in the CBD. CBD clearance was successful in 19 patients (88%), 8 were completed by a transcystic approach and 14 by a transcholedochal approach. Postoperative length of stay was 12 (+10) days. One patient had an unplanned readmission within 30 days. One patient required reoperation for bleeding. Three patients developed recurrent stones and 1 developed a subsequent stricture. No mortalities were recorded. Conclusion: LCBDE is feasible and appears safe as a secondary procedure after failed ERCP. The new technologies and the advancement of surgical techniques will continue to improve success and reduce morbidity.

Novel elbow basket mechanical lithotripter for large common bile duct stone removal

ABSTRACT Background Large common bile duct (CBD) stones often require lithotripsy. In this study, we aimed to introduce a novel device-elbow basket catheter for mechanical lithotripsy (ML) of CBD stones and assess the efficacy and safety of the novel device. Methods This was a retrospective study. A total of 139 patients with large CBD stones who underwent lithotripsy using the elbow basket mechanical lithotripter (EBML) or conventional basket mechanical lithotripter (CBML) during endoscopic retrograde cholangiopancreatography (ERCP) from June 2016 to September 2021 in our center were enrolled in the study. The stone clearance rate, intubation time, overall procedure time, and adverse event rate were compared between the two groups. Results The stone clearance rate in the first ERCP program in the EBML (n = 71) group was significantly higher than that in the CBML (n = 68) group (98.6% vs. 88.2%; P< 0.05). The intubation time in the EBML group was significantly shorter than that in the CBML group (median time; 12s vs. 78s; P< 0.001). The overall procedure time in the EBML group was significantly shorter than that in the CBML group (median time; 51 min vs. 63 min; P< 0.001). The adverse event rate (7.4% vs. 1.4%: P> 0.05) was similar between the two groups. Conclusions ML using EBML in patients with large CBD stones is feasible and safe. Compared with the CBML, the stone clearance rate of the EBML is higher in a single procedure and decreases the time of intubation and the overall procedure.

Comparison of one-stage laparoscopic common bile duct exploration plus cholecystectomy and two-stage endoscopic sphincterotomy plus laparoscopic cholecystectomy for concomitant gallbladder and common bile duct stones in patients over 80 years old.

PurposeThis study was performed to compare the safety and efficacy of one-stage laparoscopic common bile duct exploration (LCBDE) plus laparoscopic cholecystectomy (LC) with those of endoscopic sphincterotomy (EST) plus LC for concomitant gallbladder (GB) and common bile duct (CBD) stones in elderly patients.MethodsThis single-center retrospective study reviewed the medical records of patients aged >80 years who were diagnosed with concomitant GB and CBD stones between January 2010 and December 2020.ResultsOf the 137 patients included in this study, 46 underwent one-stage LCBDE + LC and 91 underwent two-stage EST + LC. The frequency of previous gastrectomy (23.9% vs. 5.5%, p = 0.002) and multiple stones (76.1% vs. 49.5%, p = 0.003) was higher in the LCBDE + LC group than in the EST + LC group. Further, patients in LCBDE + LC group had larger CBD stones (11.9 mm vs. 6.0 mm, p < 0.001). There were no significant differences in the clearance (91.3% vs. 95.6%, p = 0.311) and recurrence (4.3% vs. 8.8%, p = 0.345) rates between the groups. The incidence of posttreatment overall complications (17.4% vs. 22.0%, p = 0.530) and total hospital stay (12.7 days vs. 11.7 days, p = 0.339) were similar in the two groups.ConclusionOne-stage LCBDE + LC is a safe and effective treatment for concomitant GB and CBD stones, even in elderly patients, and may be considered as the first treatment option in elderly patients with previous gastrectomy, multiple large (≥ 15 mm) CBD stones, or inability to cooperate with endoscopic procedures.

Comparison of endoscopic papillary large‐balloon dilatation with endoscopic sphincterotomy in clearing large common bile duct stones: A systematic review and meta‐analysis of randomized controlled trials

AbstractThere are three methods to retrieve large common bile duct stones, the first is endoscopic sphincterotomy (EST), the second is endoscopic papillary large‐balloon dilatation (EPLBD), and the third is limited EST plus EPLBD. Although EST is the most popularly used method, it has higher risk of bleeding complication and basket stuck. EPLBD alone without EST demonstrated safe and quick in the clinical practice, but there were only few studies focused on comparing EST or EPLBD alone. Thus, this study aims to compare the efficacy and safety of EPLBD with EST. We searched for PubMed, Embase, and Cochrane Library databases to collect relevant articles until August 31st, 2019. We included randomized controlled trials, common bile duct stones &gt; 10 mm, comparison of endoscopic papillary large‐balloon dilatation with endoscopic sphincterotomy, and patients older than 18. We compare endoscopic papillary large‐balloon dilatation with endoscopic sphincterotomy on the clearance of large common bile duct stones, the adverse events, and the need for mechanical lithotripsy. This systematic review and meta‐analysis was registered on PROSPERO and the registration number is CRD42020150485. Total six studies met inclusion criteria and 762 participants were enrolled. The data revealed that endoscopic papillary large‐balloon dilatation alone was comparable to endoscopic sphincterotomy on the clearance of large common bile duct stones (RR = 1.02, 95% CI: 0.93‐1.12), the adverse events (RR = 1.01, 95% CI: 0.71‐1.43) and the need for mechanical lithotripsy. In the subgroup analysis, the requirement of mechanical lithotripsy decreased in the non‐Chinese group (RR = 0.58, 95% CI: 0.41‐0.84). The efficacy and safety to clean large common bile duct stones are comparable in either EPLBD or EST. In addition, EPLBD alone not only saves the operation time but also reduces the chance of mechanical lithotripsy in the subgroup analysis.

Endoscopic papillary large balloon dilation with or without sphincterotomy for extraction of large bile duct stones

ObjectivesThis work aimed to evaluate the safety and efficacy of endoscopic papillary large balloon dilatation (EPLBD) with or without endoscopic sphincterotomy (EST) in extraction of large common bile duct stones (CBDSs).BackgroundEST combined with EPLBD has been proposed as an alternative to manage large bile duct stones. However, recent reports indicate that EPLBD alone may be safe and effective in this setting.Patients and methodsFrom July 2019 to December 2021, we prospectively compared EPLBD alone (group I, n=100) with EST+EPLBD (group II, n=100) for the treatment of large CBDSs. CBDS clearance rate, frequency of mechanical lithotripsy usage, total procedure time, and intraendoscopic and postendoscopic complications were analyzed.ResultsStatistical analysis revealed that there were no significant differences between the studied groups regarding the use of mechanical lithotripsy (6 vs. 8%, P=0.579), overall and initial stone clearance rates (92 vs. 88%, P=0.346; and 81 vs. 76%, P=0.389, respectively), procedure-related pancreatitis (3 vs. 1%, P=0.312), or other intraendoscopic and postendoscopic adverse events, but there was a significant difference in terms of total procedure time (41.23±10.6 vs. 36.87±8.06, P=0.001).ConclusionThe therapeutic outcomes and complications of sole EPLBD for the removal of large CBDSs were comparable to those of EPLBD with prior EST.

Peroral contact lithotripsy in the treatment of large common bile duct stones

<h3>ЦЕЛЬ ИССЛЕДОВАНИЯ</h3> Сравнить два метода лечения крупного холедохолитиаза — механическую литотриписию и контактную литотрипсию. <h3>МАТЕРИАЛ И МЕТОДЫ</h3> За период с января 2019 по апрель 2022 г. в НИИ скорой помощи им. Н.В. Склифосовского поступили 605 пациентов с диагнозом «холедохолитиаз», которым была выполнена транспапиллярная литоэктстракция из холедоха. Из них в исследование были включены 53 (8,8%) пациента, у которых были выявлены крупные конкременты (более 15 мм в диаметре). Удаление конкрементов у этой группы больных с помощью корзины Дормиа или литоэкстракционного баллона технически было безуспешным и потребовало их разрушения. <h3>РЕЗУЛЬТАТЫ</h3> Методика механической литотрипсии была применена у 35 пациентов, у 18 — контактная. Эффективность механической литотрипсии составила 72%. Осложнения были зарегистрированы у 2 пациентов. Контактная литотрипсия была эффективна во всех случаях, при этом постманипуляционных осложнений не возникало. <h3>ЗАКЛЮЧЕНИЕ</h3> Настоящее исследование показало 100% эффективность и безопасность электрогидравлической и лазерной литотрипсии под контролем SpyGlass в четко определенной группе пациентов с крупными камнями в желчных протоках.