Small sphincterotomy combined with endoscopic papillary large balloon dilation vs sphincterotomy alone for removal of common bile duct stones

Abstract

Aim: To evaluate the efficacy and safety of endoscopic papillary large diameter balloon dilation (EPLBD) following limited endoscopic sphincterotomy (EST) and EST alone for removal of large common bile duct (CBD) stones.

Methods: We retrospectively compared EST + EPLBD (group A, n = 64) with EST alone (group B, n = 89) for the treatment of large or multiple bile duct stones. The success rate of stone clearance, procedure-related complications and incidents, frequency of mechanical lithotripsy use, and recurrent stones were recorded.

Results: There was no statistically significant difference between the two groups regarding periampullary diverticula (35.9% vs 34.8%, P > 0.05), pre-cut sphincterotomy (6.3% vs 6.7%, P > 0.05), size (12.1 ± 2.0 mm vs 12.9 ± 2.6 mm, P > 0.05) and number (2.2 ± 1.9 vs 2.4 ± 2.1, P > 0.05) of stones or the diameters of CBD (15.1 ± 3.3 mm vs 15.4 ± 3.6 mm, P > 0.05). The rates of overall stone removal and stone removal in the first session were not significantly different between the two groups [62/64 (96.9%) vs 84/89 (94.4%), P > 0.05; and 58/64 (90.6%) vs 79/89 (88.8%), P > 0.05, respectively]. The rates of post-endoscopic retrograde cholangiopancreatography pancreatitis and hyperamylasemia were not significantly different between the two groups [3/64 (4.7%) vs 4/89 (4.5%), P > 0.05; 7/64 (10.9%) vs 9/89 (10.1%), P > 0.05, respectively]. There were no cases of perforation, acute cholangitis, or cholecystitis in the two groups. The rate of bleeding and the recurrence of CBD stones were significantly lower in group A than in group B [1/64 (1.6%) vs 5/89 (5.6%), P < 0.05; 1/64 (1.6%) vs 6/89 (6.7%), P < 0.05, respectively].

Conclusion: EST + EPLBD is an effective and safe endoscopic approach for removing large or multiple CBD stones.

Keywords: Choledocholithiasis; Endoscopic papillary balloon dilation; Endoscopic retrograde cholangiopancreatography; Endoscopic sphincterotomy.

Figure 1

Fluoroscopic view of large-balloon dilatation following limited sphincterotomy. A: Cholangiogram demonstrating two large stones within the dilated bile duct; B: A large balloon inflated across the papilla over the guidewire; C: The cholangiogram following complete stone removal showed no residual filling defect in the bile duct; D: The placement of a nasobiliary drainage tube.

Figure 2

Endoscopic view of large-balloon dilation following limited sphincterotomy. A: Endoscopic small sphincterotomy; B: A large balloon inflated across the papilla; C: Markedly dilated papilla following large-balloon dilation; D: A large stone extracted using a retrieval balloon catheter through the dilated papilla.