Comparison of the usefulness of endoscopic papillary large-balloon dilation with endoscopic sphincterotomy for large and multiple common bile duct stones

BMC Gastroenterology

Hideyuki Hiraishi¹  Takako Sasai¹  Naoto Yoshitake¹  Chieko Tsuchida¹  Tsunehiro Suzuki¹  Misako Tsubouchi¹  Mari Iwasaki¹  Kouhei Tsuchida¹ 

[1] Department of Gastroenterology, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Shimotsuga 321-0293, Tochigi, Japan

关键词: Endoscopic retrograde cholangiopancreatography;    Common bile duct stone;    Endoscopic papillary large-balloon dilation;   

Others  :  1211529
DOI  :  10.1186/s12876-015-0290-6

 received in 2014-12-15, accepted in 2015-05-11,  发布年份 2015

【 摘 要 】

Background

Endoscopic sphincterotomy (EST) is currently recognized as the primary endoscopic treatment for common bile duct stones. However, it is difficult to remove multiple (≥3) or large (≥15 mm) common bile duct stones with EST alone. Recently, EST plus endoscopic papillary large-balloon dilation (EPLBD) was reported to be an effective treatment for such bile duct stones. We compared the results of EST and EST + EPLBD for multiple (≥3) or large (≥15 mm) stones that were difficult to treat using EST alone. We also compared the complication rates between the techniques.

Methods

Seventy patients with large (largest diameter, ≥15 mm) or ≥ 3 common bile duct stones treated in our department between April 2010 and March 2013 underwent EST + EPLBD (n = 34) or EST alone (n = 36). We compared final successful stone removal rates, rates of successful stone removal in the first session, procedure times, status of concurrent mechanical lithotripsy (ML), and complications between the EST + EPLBD and EST groups.

Results

The rates of final successful stone removal were similar between the two groups (EST + EPLBD: 100 % vs. EST: 89 %; p = 0.115). The rate of successful stone removal in the first session was significantly higher in the EST + EPLBD group (EST + EPLBD: 88 % vs. EST: 56 %; p = 0.03). Moreover, the procedure time was significantly shorter (EST + EPLBD: 42 min vs. EST: 67 min; p = 0.011) and the rate of ML use was significantly lower in the EST + EPLBD group (EST + EPLBD: 50 % vs. EST: 94 %; p < 0.001). Complications like pancreatitis and bleeding occurred in three patients in the EST + EPLBD group and in 10 patients in the EST group, but the differences were not statistically significant (EST + EPLBD: 9 % vs. EST: 25 %; p = 0.112).

Conclusions

Our results suggest that EST + EPLBD is an effective therapy for patients with difficult-to-treat multiple or large common bile duct stones, because it requires fewer sessions and shorter operative times than EST alone.

【 授权许可】

   
2015 Tsuchida et al.; licensee BioMed Central.

【 图 表 】

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【 参考文献 】

• [1]Binmoeller KF, Schafer TW: Endoscopic management of bile duct stones. J Clin Gastroenterol 2001, 32(2):106-18.
• [2]Cipolletta L, Costamagna G, Bianco MA, Rotondano G, Piscopo R, Mutignani M, et al.: Endoscopic mechanical lithotripsy of difficult common bile duct stones. Br J Surg 1997, 84(10):1407-9.
• [3]Neuhaus H: Endoscopic and percutaneous treatment of difficult bile duct stones. Endoscopy 2003, 35(8):S31-4.
• [4]Seitz U, Bapaye A, Bohnacker S, Navarrete C, Maydeo A, Soehendra N: Advances in therapeutic endoscopic treatment of common bile duct stones. World J Surg 1998, 22(11):1133-44.
• [5]Demling L, Seuberth K, Riemann JF: A mechanical lithotripter. Endoscopy 1982, 14(3):100-1.
• [6]Ando T, Tsuyuguchi T, Okugawa T, Saito M, Ishihara T, Yamaguchi T, et al.: Risk factors for recurrent bile duct stones after endoscopic papillotomy. Gut 2003, 52(1):116-21.
• [7]Saito M, Tsuyuguchi T, Yamaguchi T, Ishihara T, Saisho H: Long-term outcome of endoscopic papillotomy for choledocholithiasis with cholecystolithiasis. Gastrointest Endosc 2000, 51(5):540-5.
• [8]Ersoz G, Tekesin O, Ozutemiz AO, Gunsar F: Biliary sphincterotomy plus dilation with a large balloon for bile duct stones that are difficult to extract. Gastrointest Endosc 2003, 57(2):156-9.
• [9]Tsujino T, Komatsu Y, Isayama H, Hirano K, Sasahira N, Yamamoto N, et al.: Ulinastatin for pancreatitis after endoscopic retrograde cholangiopancreatography: a randomized, controlled trial. Clin Gastroenterol Hepatol 2005, 3(4):376-83.
• [10]Freeman ML, Guda NM: Prevention of post-ERCP pancreatitis: a comprehensive review. Gastrointest Endosc 2004, 59(7):845-64.
• [11]Cotton PB, Lehman G, Vennes J, Geenen JE, Russell RC, Meyers WC, et al.: Endoscopic sphincterotomy complications and their management: an attempt at consensus. Gastrointest Endosc 1991, 37(3):383-93.
• [12]Kawai K, Akasaka Y, Murakami K, Tada M, Koli Y: Endoscopic sphincterotomy of the ampulla of Vater. Gastrointest Endosc 1974, 20(4):148-51.
• [13]Itoi T, Itokawa F, Sofuni A, Kurihara T, Tsuchiya T, Ishii K, et al.: Endoscopic sphincterotomy combined with large balloon dilation can reduce the procedure time and fluoroscopy time for removal of large bile duct stones. Am J Gastroenterol 2009, 104(3):560-5.
• [14]Stefanidis G, Viazis N, Pleskow D, Manolakopoulos S, Theocharis L, Christodoulou C, et al.: Large balloon dilation vs mechanical lithotripsy for the management of large bile duct stones: a prospective randomized study. Am J Gastroenterol 2011, 106(2):278-85.
• [15]Kim HG, Cheon YK, Cho YD, Moon JH, Park Do H, Lee TH, et al.: Small sphincterotomy combined with endoscopic papillary large balloon dilation versus sphincterotomy. World J Gastroenterol 2009, 15(34):4298-304.
• [16]Kim TH, Oh HJ, Lee JY, Sohn YW: Can a small endoscopic sphincterotomy plus a large-balloon dilation reduce the use of mechanical lithotripsy in patients with large bile duct stones? Surg Endosc 2011, 25(10):3330-7.
• [17]García-Cano J, Arana LT, Ayllón CJ, Chicano MV, Fernández RM, Sánchez LS, et al.: Biliary sphincterotomy dilation for the extraction of difficult common bile duct stones. Rev Esp Enferm Dig 2009, 101(8):541-5.
• [18]Heo JH, Kang DH, Jung HJ, Kwon DS, An JK, Kim BS, et al.: Endoscopic sphincterotomy plus large-balloon dilation versus endoscopic sphincterotomy for removal of bile-duct stones. Gastrointest Endosc 2007, 66(4):720-6.
• [19]Feng Y, Zhu H, Chen X, Xu S, Cheng W, Ni J, et al.: Comparison of endoscopic papillary large balloon dilation and endoscopic sphincterotomy for retrieval of choledocholithiasis: a meta-analysis of randomized controlled trials. J Gastroenterol 2012, 47(6):655-63.
• [20]Freeman ML, Nelson DB, Sherman S, Haber GB, Herman ME, Dorsher PJ, et al.: Complications of endoscopic biliary sphincterotomy. N Engl J Med 1996, 335(13):909-18.
• [21]Mallery JS, Baron TH, Dominitz JA, Goldstein JL, Hirota WK, Jacobson BC, et al.: Complications of ERCP. Gastrointest Endosc 2003, 57(6):633-8.
• [22]Bergman JJ, van der Mey S, Rauws EA, Tijssen JG, Gouma DJ, Tytgat GN, et al.: Long-term follow-up after endoscopic sphincterotomy for bile duct stones in patients younger than 60 years of age. Gastrointest Endosc 1996, 44(6):643-9.
• [23]Leung JW, Tu R: Mechanical lithotripsy for large bile duct stones. Gastrointest Endosc 2004, 59(6):688-90.
• [24]Lee SH, Park JK, Yoon WJ, Lee JK, Ryu JK, Kim YT, et al.: How to predict the outcome of endoscopic mechanical lithotripsy in patients with difficult bile duct stones? Scand J Gastroenterol 2007, 42(8):1006-10.
• [25]Chang WH, Chu CH, Wang TE, Chen MJ, Lin CC: Outcome of simple use of mechanical lithotripsy of difficult common bile duct stones. World J Gastroenterol 2005, 11(4):593-6.
• [26]Minami A, Hirose S, Nomoto T, Hayakawa S: Small sphincterotomy combined with papillary dilation with large balloon permits retrieval of large stones without mechanical lithotripsy. World J Gastroenterol 2007, 13(15):2179-82.
• [27]Kim JH, Yang MJ, Hwang JC, Yoo BM: Endoscopic papillary large balloon dilation for the removal of bile duct stones. World J Gastroenterol 2013, 19(46):8580-94.
• [28]Yasuda I, Fujita N, Maguchi H, Hasebe O, Igarashi Y, Murakami A, et al.: Long-term outcomes after endoscopic sphincterotomy versus endoscopic papillary balloon dilation for bile duct stones. Gastrointest Endosc 2010, 72(6):1185-91.