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

BMC Gastroenterology

Research Article

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

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

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

DOI  :  10.1186/s12876-015-0290-6

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

来源: Springer

【 摘 要 】

BackgroundEndoscopic 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.MethodsSeventy 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.ResultsThe 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).ConclusionsOur 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】

CC BY   
© Tsuchida et al.; licensee BioMed Central. 2015