Endoscopic sphincterotomy combined with large balloon dilation for bile duct stones
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Objective To evaluate the therapeutic efficacy and safety of endoscopic sphincterotomy （EST） combined with large balloon dilation for bile duct stones. Methods A total of 83 patients with com- mon bile duct stones were randomly divided into 2 groups to receive standard EST （n = 41, EST group） or EST plus large balloon dilation （ n = 42, EPLBD group） , respectively. The number of endoscopic session, operation time, rates of successful complete stone retrieval, mechanical lithotripsy, and procedure related complication were compared between the two groups. Results The rate of early procedure-related complica- tions was similar in 2 groups （9/41 vs. 7/42, P 〉 0. 05 ）, including perforation （ 1/41 vs. 0/42, P 〉 0. 05 ）, bleeding （5/41 vs. 2/42, P 〉0. 05） and pancreatitis （3/41 vs. 5/42, P 〉0. 05）. The rate of suc- cessful complete stone removal was also similar in 2 groups （39/41 vs. 41/42, P 〉 0. 05）. However, EST group needed more procedure time （38. 8 ± 4. 3 min vs. 29.2 ± 5.3 rain, P 〈 0. 01 ） and use of mechanical lithotripsy to achieve complete stone removal （9/41 vs. 2/42, P 〈 0. 05 ）. Only one patient in EPLBD group （ 1/42, 2.4% ） needed a second ERCP to clear bile duct stone, while in EST group, 8 patients underwent a second procedure （ 19. 5% , P 〈 0. 05）. Conclusion For endoscopic removal of common bile duct stones, EST combined with large balloon dilation is as safe and effective as EST, while easier in manipulation.
Key words:
Common bile duct calculi; Sphincterotomy; Endoscopic; Balloon dilatationKeywords:
Balloon dilation
Perforation
Objective To assess the effectiveness and safety of endoscopic papillary large-balloon dilation(EPLBD) plus endoscopic sphincterotomy(EST) for removal of large common bile duct stones(CBDSs).Methods Patients with large CBDS treated between January 2011 and July 2012 were randomized to EPLBD+EST or EST group.The success rate of complete stone removal,one-time stone-clearance rate,the usage of mechanical lithotripsy,procedure time,X-ray exposure time and complications were compared between the two groups.Results There were no significant differences between the two groups in terms of the success rate of complete stone removal,one-time stone-clearance rate,and complications(P0.05).The usage of mechanical lithotripsy in EPLBD+EST group was less than that in EST group(χ2=3.976,P0.05).The average operation time and X-ray exposure in EPLBD+EST group were shorter than that in EST group(t=2.704,2.582;P0.05).Conclusion EPLBD plus EST is a safe and effective treatment for removal of large CBDSs.
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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
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Major duodenal papilla
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Background : The combined use of small endoscopic sphincterotomy (EST) followed by endoscopic papillary large balloon dilation (EPLBD) might be associated with a lower incidence of procedure-related complications such as pancreatitis, bleeding or perforation, compared to the use of EPLBD or a large EST alone. The aim of this retrospective study was to evaluate the utility of a combined EST and EPLBD method for the removal of common bile duct (CBD) stones that could not be extracted by use of an EST and conventional techniques. Methods : Between March 2005 and September 2006, a total of 35 patients with CBD stones were enrolled. Fourteen patients had received a previous EST, and 21 patients underwent an EST. The sphincterotomy site was then dilated with a 12~18 mm diameter balloon. Results : The average number of stones was 3.6±2.9 (range: 110). The average maximum stone diameter was 26.11 ±8.88 mm (range: 12~50 mm). Complete stone removal was accomplished in 31 patients (88.6%). In 9 patients (25.7%), a mechanical lithotripsy was required. No episode of true pancreatitis occurred. A procedure-related perforation occurred in one patient (2.8%) and the patient was treated with NPO and antibiotics. No procedure-related bleeding or mortality was observed. The procedure was performed safely in 9 patients (25.7%) with a periampullary diverticulum and in 14 patients (40.0%) with a previous EST. Conclusions : Combined EST and EPLBD may be a safe and effective method, and may be a good alternative treatment for removing CBD stones that cannot be extracted by an EST and conventional techniques. However, prospective studies based on a large number of patients are needed.
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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.
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[Objective] To compare the therapy effect of EST plus LBD with that of EST alone for bile-duct stones.[Methods] 200 patients with bile-duct stones(1 cm) were randomized in equal numbers to EST plus LBD or EST alone,comparing the rates of successful stone removal,use of mechanical lithotripsy,the procedure time and complications.[Results] The rates of successful stone removal in EST plus LBD and EST alone group were 98.0% and 97.0% respectively;The use of mechanical lithotripsy was 18% and 43% respectively.The procedure time were 21min and 46min respectively;the total complications were 3.0% and 5.0% respectively(bleeding were 1% and 2.0% and pancreatitis were 2.0% and 3.0% respectively).No perforation occurred in both groups.[Conclusions] For large bile duct stones,the procedure time in EST plus LBD was shorter than EST alone and the rates of use of mechanical lithotripsy in EST plus LBD were lower than EST alone.The rates of successful stone removal and complications were similar between the 2 groups.EST plus LBD is a safe and effective treatment for endoscopic removal of common bile duct stones.
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Background/Aims: The extraction of large common bile duct (CBD) stones after an endoscopic sphincterotomy(EST) is successful in 80∼90% of cases but it often requires a prolonged time and repeated trials. This study investigated the utility of a combined endoscopic papillary large balloon dilatation (EPLBD) and a mid-incision of an EST (m-EST) method for the removal of large CBD stones. Methods: Thirty patients with large CBD stones were enrolled in this study. EPLBD was carried out using the one-step inflation of a 15∼18 mm diameter balloon after m-EST. Results: The maximum stone diameter was 21.62±5.38 mm. Twelve patients had more than 4 stones, 7 patients had 2 stones, and the remainder had a single large stone. Complete ductal clearance was achieved in all patients. After the procedure, the serum amylase and/or lipase levels were elevated in 3 patients (13.3%). However, there was no episode of true pancreatitis. Minor bleeding was encountered in only one patient (3.3%), and was easily controlled by an endoscopic epinephrine injection. The procedure was carried out safely in 6 patients with periampullary diverticulum. No perforation or mortality was encountered. Conclusions: Combined EPLBD and m-EST is a safe and effective method, and may be a good alternative treatment for removing large CBD stones.
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To evaluate the efficacy and safety of endoscopic papillary large-balloon dilation (EPLBD) combined with limited endoscopic sphincterotomy (EST) for the removal of large biliary duct stones (≥10 mm).Data of patients who underwent an attempted removal of large bile duct stones by limited EST followed by EPLBD (≥12 mm in diameter) from April 2006 to October 2011 in our center were reviewed. Clinical characteristics, endoscopic methods and outcomes of the patients were collected and analyzed.A total of 169 patients with a mean age of 69.3 years (range 19-97 years) underwent 171 procedures. Median stone size and balloon diameter was 15 mm and 13 mm, respectively. Complete stone removal in a single session was achieved in 163 procedures (95.3%) with mechanical lithotripsy (ML) used in 66 (38.6%). Patients with a larger stone size required more frequent use of ML with a comparable success rate (P < 0.01). There were no significant differences between patients with and without periampullary diverticula in stone clearance (97.3% vs 93.8%), ML requirement (36.5% vs 40.2%) and complications (2.7% vs 6.2%) (all P > 0.05). Seven patients had eight procedure-related complications including moderate or mild bleeding (n = 4), minor perforation (n = 1), mild pancreatitis (n = 2) and cholangitis (n = 1).EPLBD following limited EST is an effective and safe approach for the removal of large biliary duct stones, especially for those refractory cases.
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Refractory (planetary science)
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Objectiye To evaluate the therapeutic efficacy and safety of （endoscopic sphincterotomy, EST） plus balloon dilation for difficult bile duct stones. Methods Patients with difficult common bile duct stones on endoscopic retrograde cholangiopancreatography （ERCP） from March 2008 to December 2009 were randomly divided into 2 groups to receive EST or EST plus balloon dilation （ EST ＋ EPBD）, respectively. The success rate of complete stone removal, number of endoscopic sessions, the rate of using mechanical lithotripsy and the complication rate related to the procedure were compared between the 2 groups. Results Compared with EST alone, EST plus balloon dilation resulted in similar outcomes in terms of overall successful stone removal rate （2/62 vs. 2/61 ） and early complication rate （4/62 vs. 6/61, P ＞0. 05）. However,EST group needed more sessions （ EST 15/46 vs. EST ＋ EPBD 5/57, P ＜0. 05） and use of mechanical lithotripsy to achieve complete removal of stones （ EST 12/61 vs. EST ＋ EPBD 4/61, P ＜0. 05 ）. Conclusion EST plus balloon dilation is as safe and effective as, but more convenient than EST, for endoscopic removal of common bile duct stones.
Key words:
Common bile duct stone; Sphincterotomy, endoscopic; Balloon dilation
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