Study on 60 cases of common bile duct stone, there different modality of management and its inference

Background: The aim of the study was to determine the best treatment modality for common bile duct stone become more challenging as large number of options available such as endoscopic, laparoscopic or open surgical methods, we need to choose specific therapy according to patient’s clinical conditions, and individual expertise.Methods: It is prospective study including 60 patient having common bile duct stone along with gall bladder stone, its different modality of management and its inference, conducted in Bhopal Memorial Hospital and Research Centre, Bhopal, during period of January 2017 to January 2020.Results: In 60 cases 41 patients undergoes to endoscopic retrograde cholangio pancreatography (ERCP) first, stone successfully removed in 34 patients and stent placed, one patients developed pancreatitis after ERCP, managed conservatively, In 6 patients retained stone after ERCP procedure, one patients developed surgical emphysema after procedure, managed with ICD and conservatively, and one patient had bleeding during sphincterotomy so its procedure abandoned and one of the patient failed to cannulate common bile duct (CBD).  21 patients undergo laparoscopic common bile duct explorations, 2 lap CBD exploration converted to open CBD exploration with cholecystectomy, due to adhesion at hepatocystic triangle. Five patients undergoes open CBD exploration, in one patient hepaticojejunostomy was done as patient was having CBD stone with stricture. No mortality during and after procedure.Conclusions: Management of CBD stone is depends upon individual expertise and available modality. If surgeons are expertise then lap CBD exploration with cholecystectomy without attempting to ERCP guide stone removal is best approach in majority of patients.

Interventional therapy for common bile duct stones: analysis of curative effect / 介入放射学杂志

Objective To evaluate the clinical curative effect of multiple interventional techniques with skilled manipulation in treating common bile duct stones. Methods The clinical data of 36 patients with common bile duct stones, who were treated with percutaneous transhepatic puncture of intrahepatic bile duct and multiple interventional techniques, were retrospectively analyzed. Before operation, according to CT or MRI findings the optimal puncture path was selected to perform cholangiography so as to reconfirm the position, number and size of the stones. Depending on the size of the stone, the corresponding sized lithotripsy basket and balloon were selected. The duodenal papilla was dilated by balloon, and the stone was pushed into the duodenum with a balloon. After complete removal of stones, the internal and external biliary drainage tubes were routinely implanted and remained there for two weeks. Results The operation was successfully accomplished in 35 patients, the success rate was 97.2％. Successful removal of stones with single procedure was accomplished in 32 patients, and in 3 patients the complete removal of stones was achieved by secondary procedure. No serious complications were observed during the operation. Early postoperative complications included hyperamylasemia (n=2), bile peritonitis (n=2), small amount of bloody bile (n=3) . No biliary perforation occurred. Conclusion In treating common bile duct stones, the combination use of multiple interventional techniques with skilled manipulation has high success rate, low risk and less complications, therefore, it is an effective therapeutic method

Endoscopic papillary large balloon dilation for common bile duct stones / 中华肝胆外科杂志

Objective To study the clinical efficacy and safety of endoscopic papillary large balloon dilation (EPLBD) in the treatment of common bile duct (CBD) stones.Methods This retrospective study of EPLBD for CBD stoneswas conducted between May 2015 and March 2017 on 116 patients.The patients were divided into two groups based on the different methods of treatment:group A (the EPLBD group) and B(the EST + EPBD group).Results Treatment with EPLBD when compared with EST + EPBD produced similar outcomes with regard to the overall stone removal rates (96.2％ vs.93.5％,P ＞ 0.05) and complete ductal clearance in one session (92.6％ vs.92％,P ＞0.05).There were no significant differences in the rates of overall complication (22.2％ vs.22.2％,P ＞ 0.05),hemorrhage (7.4％ vs.11.3％,P ＞ 0.05),post-ERCP pancreatitis (9.3％ vs.6.6％,P ＞ 0.05) and acute cholangitis (5.6％ vs.8.1％,P ＞0.05).When compared with EST + EPBD,mechanical lithotripsy was performed less in the EPLBD group (16.6％ vs.27.4t％,p ＜ 0.05).Conclusions EPLBD was an effective and safe method to treat CBD stones.EPLBD reduced the use of mechanical lithotripsy when compared with EST + EPBD.

Incidence of Choledocholithiasis in Gallstone Disease in Eastern Zone of India: A Single Centre Study

Common bile duct stones are found in 10-15% of patients having gall stone disease and the incidence increases with the age, both in India and in western countries and the majority of common bile duct stones are secondary to gall bladder stones, their incidence is more in Northern India

The clinical application of laparoscopic common bile duct stone removal / 中华肝胆外科杂志

Cholecystolithiasis with choledocholithiasis (CCL) is a common disease.The removal of common bile stone is a challenge for the surgery.This paper discussed the clinical application of three stone removal techniques including direct stone removal,irrigation and stone extraction by basket under cholangioscopy in order to take the stones effectively and safely,shorten the procedure time,avoid the injuries of common bile duct wall caused by the repetition of a single method such as biliary endoscopic stone extraction,reduce the difficulty of taking stone and enhance recovery of patients.

"The feasibility of ""one-stage and two classification"" method to treat concomitant gallbladder stones and common bile duct stones" / 中华肝胆外科杂志

Objective To study the efficacy and feasibility of the one-stage and two classification method to treat concomitant gallbladder stones and common bile duct stones.Methods 56 consecutive patients with concomitant gallbladder stones and common bile duct stones in Central Hospital of Huzhou were treated with the one-stage and two classification method from January 2013 to January 2017.According to the size and quantity,common bile duct stones were divided into difficult stones and non difficult stones.In plan A (n =35),endoscopic stone clearance and laparoscopic cholecystectomy were undertaken in a single operation to treat non difficult stones,In plan B (n =21),laparoscopic cholecystectomy and CBD exploration without T-tube insertion were undertaken in a single operation to treat difficult stones.The operation success rate,postoperative complications,hospitalization stay and follow-up outcomes were analyzed.Results Fifty-six patients were enrolled in the study.Fifty-one patients were treated by the one-stage and two classification method.Among them,thirty-two patients followed treatment plan A.Three patients were convened to plan B because of failure of bile duet intubation.Nineteen patients were treated by plan B.One patient was converted to laparotomy,and another underwent T-tube drainage.The incidence of complication was 7.1％.Post-ERCP pancreatitis happened in one patient.Post ERCP bleeding happened in another patient (1.6％).Bile leakage occurred in one patient,and incision infection occurred in one patient.There were no deaths.During a follow-up of 6-24 months,no stone recurrence and bile duct stenosis were observed.Conclusion The one-stage and two classification method was an effective and feasible alternative to manage concomitant gallbladder stones and common bile duct stones.

Percutaneous transhepatic removal of gall-stone technique for the treatment of common bile duct stones: initial experience in 25 patients / 介入放射学杂志

Objective To discuss the clinical application of percutaneous transhepatic removal of gall-stone technique in treating common bile duct (CBD) stones.Methods Between January 2013 and January 2015,a total of 25 patients with CBD stones underwent lithotomy procedure via percutaneous transhepatic route.First,under ultrasound or fluoroscopy guidance percutaneous transhepatic cholangiography (PTC) was performed with subsequent placement of an 8 F rsheath;then,a balloon of 8-12 mm diameter was employed to dilate the papilla;mechanical lithotripsy was adopted when the stone size exceeded 12 mm;finally,through guide-wire exchange technique the stone-retrieval balloon was used to push the stones into the intestinal tract through the sphincter of duodenal papilla.Results The reasons to receive percutaneous transhepatic removal of gall-stone technique in the 25 patients included previous gastrointestinal surgery (n=18),endoscopic treatment failure (n=3),unwilling to receive endoscopic treatment (n=3),and other reasons (n=1).Successful removal of stones was accomplished in all 25 patients.After the treatment,complications occurred in 3 patients (12％),including fever (n=2) and liver abscess formation (n=1).The patients were followed up for 0.5-3 years;two patients died of tumor recurrence and metastasis,and one patient developed recurrence of common bile duct stones.No reflux cholangitis occurred.Conclusion For the treatment of CBD stones,percutaneous transhepatic removal of gall-stone technique carries higher technical success rate with lower incidence of complications,therefore,this technique can be used for the patients who are not suitable for endoscopic treatment or in whom endoscopic treatment failed.

Diagnostic value of serum liver function indexes for gallbladder stones combined with asymptomatic secondary common bile duct stones / 中华消化外科杂志

Objective To investigate the diagnostic value of serum liver function indexes for gallbladder stones combined with asymptomatic secondary common bile duct stones.Methods The retrospective cohort study was conducted.The clinical data of 460 patients with gallbladder stones who were admitted to the Affiliated Hospital of Zunyi Medical College from June 2012 to June 2016 were collected.Of 460 patients,106 combined with asymptomatic secondary common bile duct stones and 354 with gallbladder stones were allocated into the common bile duct stone group and gallbladder stone group,respectively.The serum liver function test was applied to the 2 groups,including alanine transaminase (ALT),aspartate transaminase (AST),total bilirubin (TBil),direct bilirubin (DBil),glutamyltransferase (GGT) and alkaline phosphatase (ALP).The receiver operating characteristic (ROC) curve was built using significant statistical indicators,and correspondent cut-off value,sensitivity and specificity were calculated according to ROC curve.Observation indicators:(1) comparison of serum liver function indicators (ALT,AST,TBil,DBil,GGT,ALP) between the 2 groups;(2) analysis result of ROC curve.Measurement data with normal distribution was represented as x±s.The comparison between groups was evaluated with the independent-sample t test.The comparison of count data were analyzed using the chi-square test.The ROC curve analysis was done for significant statistical indicators.Results (1) Comparison of serum liver function indicators between the 2 groups,the levels of ALT,AST,TBil and DBil were (32±8)U/L,(35±8)U/L,(12.8±2.5)μmol/L,(2.6±0.4)μmol/L in the common bile duct stone group and (30±7)U/L,(32±7)U/L,(12.2± 2.4)μmol/L,(2.5 ±0.4)μmol/L in the gallbladder stone group,respectively,with no statistically significant difference (t=0.891,0.786,0.924,1.026,P＞0.05).The levels of GGT and ALP were (162±43) U/L and (145±37) U/L in the common bile duct stone group and (36± 10)U/L and (128±23) U/L in the gallbladder stone group,respectively,with significantly statistical differences (t =20.859,2.483,P＜0.05).(2) Result of ROC curve showed that areas under the curve of GGT and ALP were respectively 0.963 [95％ confidence interval (CI):0.938-0.988] and 0.621 (95％CI:0.561-0.684).The correspondent cut-off value of diagnostic accuracy,sensitivity and specificity of GGT and ALP were 92.5 U/L and 139.5 U/L,91.6％ and 50.7％,95.7％ and 76.5％,respectively.Conclusion The abnormally elevated levels of serum GGT have major diagnostic value for patients with gallbladder stones combined with asymptomatic secondary common bile duct stones,with an advantage of convenient and fast operation,and it is worth to be applied and popularized.

Feasibility of Endoscopic Papillary Large Balloon Dilation in Patients with Difficult Bile Duct Stones without Dilatation of the Lower Part of the Extrahepatic Bile Duct

BACKGROUND/AIMS: There is no consensus for using endoscopic papillary large balloon dilation (EPLBD) in patients without dilatation of the lower part of the bile duct (DLBD). We evaluated the feasibility and safety of EPLBD for the removal of difficult bile duct stones (diameter ≥10 mm) in patients without DLBD. METHODS: We retrospectively reviewed the records of 209 patients who underwent EPLBD for the removal of bile duct stones from October 2009 to July 2014. Primary outcomes were the clearance rate and additional mechanical lithotripsy. Secondary outcomes were the incidence of complications and recurrence rate. RESULTS: Fifty-seven patients had DLBD (27.3%), and 152 did not have DLBD (72.7%). There were no significant differences in the overall success rate or the use of mechanical lithotripsy. Success rate during the first session and procedure time were better in the DLBD than the without-DLBD group (75.7% vs 66.7%, 48.1±23.0 minutes vs 58.4±31.7 minutes, respectively). As for complications, there were no significant differences in the incidence of pancreatitis, perforation or bleeding after endoscopic retrograde cholangiopancreatography. The recurrence rate did not differ significantly between the two groups. CONCLUSIONS: EPLBD is a useful and safe method for common bile duct stone removal in patients without DLBD.

A Case of Suspected Intrahepatic Bile Duct Perforation after Direct Peroral Cholangioscopy / 대한췌담도학회지

Direct peroral cholangioscopy (POC) which permits direct visualization of the biliary tree has recently gained widespread clinical use for diagnosis and treatment of various pancreatobiliary diseases. But, there is currently little reliable data on evaluating the complications of POC. POC is associated with complications such as pancreatitis, cholangitis, hemorrhage, rarely air embolism, and ductal perforation. The incidence of complication during POC is 2.9-12%. However, pneumoperitoneum due to intrahepatic bile duct perforation after POC has not yet been reported in Korea. We report a case of pneumoperitoneum after POC which has been successfully managed with endoscopic nasobiliary drainage and antibiotics.

The role of liver function test in diagnosing concomitant asymptomatic common bile duct stone in patients with cholecystolithiasis / 中华肝胆外科杂志

Objective To determine the role of liver function test in the preoperative diagnosis of concomitant asymptomatic common bile duct (CBD)stone in patients with cholecystolithiasis.Methods A retrospective study was conducted from January 2012 to October 2013 at the Department of Hepatobiliary Surgery,the Affiliated Hospital of Zunyi Medical College on 426 patients who were operated for cholecystolithiasis.According to whether they had abnormal liver function,these patients were divided into the CBD stone group (n =44) and the cholecystolithiasis group (n =382).The values of the different components of liver functions test such as ALT,AST,AKP,GGT,TBIL and DBIL in diagnosing CBD stone were statistically analyzed.Results This study involved 426 patients,159 men and 231 women,with a mean age of (50.96 ± 12.93) years.44 patients with both CBD stone and cholecystolithiasis.The rates of abnormal liver function were 77.27％ (34/44) vs 4.45％ (17/382) in CBD stone group vs cholecystolithiasis group.The difference was significant (x2 =198.54 ; P =0.000).In logistic regression analysis,only elevated serum level of GGT (OR =10.067 ; P =0.007) remained as an independent predictor of CBD stone.On ROC (receiver operating characteristic) curves analysis,the area under the curve was 0.881.With a cut-off point for GGT at 84.5 U/L,there was a sensitivity of 72.2 per cent,specificity of 96.1 per cent,and positive and negative predictive values of 76.3 per cent and 96.2 per cent respectively.Conclusion Our study showed that liver function,especially GGT,was a predictor of CBD stone.

Application of Layered Suture Technique in Laparoscopic Common Bile Duct Exploration with Primary Suture / 中国微创外科杂志

Objective To explore the application value of layered suture technique in laparoscopic common bile duct exploration with primary suture. Methods A total of 216 patients received laparoscopic common bile duct exploration with primary suture in our hospital from March 2007 to March 2013.Of these cases, layered suture technique was utilized in 89 patients and single-layer suture was used in 127 patients.The operation time, postoperative hospital stay, and postoperative complications were compared between the two groups. Results Two groups of patients were operated smoothly, with no conversions to laparotomy.Postoperative recovery was smooth.The operative time was not significantly different between the two groups of patients (t=-0.931, P=0.353). The postoperative hospital stay and incidence of postoperative bile leakage were significantly lower in layered suture group than those in single-layer suture group [(5.9 ±1.7) d vs.(7.7 ±1.8) d,t =7.400, P=0.000;3.4%(3/89) vs.20.5%(26/127), χ2 =13.167, P=0.000].In the single-layer suture group, the incidence of postoperative bile leakage was significantly higher in patients complicated with acute cholangitis [45.4%(10/22) vs.15.2%(16/105),χ2 =8.429, P=0.004], whereas in the layered suture group, the incidence of postoperative bile leakage was insignificantly different among patients with and without acute cholangitis [7.1%(1/14) vs.2.7%(2/75),χ2 =0.002, P=0.964]. Conclusion Application of layered suture technique in laparoscopic common bile duct exploration with primary suture is feasible and safe, with advantages of less bile leakage and shorter hospital stay.

Late Complications and Stone Recurrence Rates after Bile Duct Stone Removal by Endoscopic Sphincterotomy and Large Balloon Dilation are Similar to Those after Endoscopic Sphincterotomy Alone

BACKGROUND/AIMS: Between endoscopic sphincterotomy (ES) alone and combined endoscopic sphincterotomy and large balloon dilation (ES-LBD) groups, efficacy and long-term complications, difference in biliary stone recurrence rate, and risk factors of stone recurrence were compared. METHODS: Medical records of 222 patients who underwent ERCP for biliary stone removal were retrospectively reviewed. Patients with dilated CBD > or =11 mm and follow-up longer than 6 months were included. RESULTS: There were 101 patients in ES-LBD group and 121 patients in ES group. Mean follow-up duration was 25.0 (6-48) months and 13.0 (6-43) months, respectively (p=0.001). There was no difference in number of ERCP sessions, brown pigment stones, angle between mid and distal common bile duct (CBD angle) <135degrees, and lithotripsy rate. Complete retrieval success rate was excellent in both groups (100% vs. 99%). Early complication rate of ES-LBD and ES alone group was 4 and 4.1%, respectively (p=1.000). One patient in ES-LBD group died from delayed bleeding. Late complication rate was 5.9 and 3.3%, respectively (p=1.000). Stone recurrence rate was 6.9% and 5.8%, respectively (p=0.984). The only Independent risk factor of stone recurrence was presence of periampullary diverticulum. CONCLUSIONS: Late complication and stone recurrence rates were similar between ES-LBD and ES alone groups.

Recurrence of Bile Duct Stones after Endoscopic Papillary Large Balloon Dilation Combined with Limited Sphincterotomy: Long-Term Follow-Up Study

BACKGROUND/AIMS: Endoscopic papillary large-balloon dilation combined with limited endoscopic sphincterotomy (EPLBD+ES) is promising for the treatment of common bile duct (CBD) stones. The aim of this study was to clarify the recurrence rate and the risk factors for CBD stones after EPLBD+ES. METHODS: In total, 100 patients who underwent EPLBD+ES from 2006 to 2007 were evaluated retrospectively. One hundred and nine patients who were treated with endoscopic sphincterotomy (ES) from 2004 to 2005 were set as the historical control group. Various risk factors for the recurrence of bile duct stones were analyzed. RESULTS: Of the 209 patients, the duration of follow-up was 32.5+/-4.5 months in the EPLBD+ES group and 31.8+/-6.0 months in the ES group. The recurrence rate of CBD stones was 11.0% (11/100) in the EPLBD+ES group and 13.8% (15/109) in the ES group (p=0.546). The cumulative recurrence rate of stones was not significantly different between the EPLBD+ES and ES groups (log rank, p=0.537). Univariate analysis showed that the diameter of the CBD (> or =22 mm) was the only predictive variable that could differentiate recurrence from nonrecurrence in the EPLBD+ES group. Multivariate analysis revealed that the diameter of the bile duct was the only risk factor for stone recurrence (p=0.022; odds ratio, 1.175; 95% confidence interval, 1.023 to 1.348). CONCLUSIONS: The recurrence rate of CBD stones after EPLBD+ES is comparable to that of the ES group, and a dilated CBD appears to increase the risk of bile duct stone recurrence.

Recurrent Common Bile Duct Stone and Endoscopic Treatment after Endoscopic Papillary Large Balloon Dilatation with Minor Endoscopic Sphincterotomy / 대한소화기학회지

BACKGROUND/AIMS: Recent studies have reported the potentials of endoscopic papillary large balloon dilatation (EPLBD) with minor endoscopic sphincterotomy (EST) for the complete removal of common bile duct (CBD) stone in the high risk groups. However, there have been no reports about the recurrence of the CBD stone after EPLBD with minor EST. The aim of this study was to evlauate the recurrence of CBD stone after EPLBD with minor EST. METHODS: A total of 1,036 patients who underwent endoscopic treatment due to CBD stones at Pusan University Hospital were enrolled. The patients were classified into two groups: those who underwent EPLBD with minor EST (group 1) and those who underwent EST treatment (group 2). We investigated clinical factors and recurrence rate between two groups. RESULTS: The recurrence of CBD stone occurred in total of 74 patients (7%), and the recurrence rates of CBD stone were 21/321 (6.5%) in Group 1 and 53/715 (7.4%) in Group 2. There were no difference in the presence of diverticulum and the number and size of recurrent CBD stone between the two groups. In case of diverticulum existence, recurrence rates were 12/158 (7.6%) in Group 1 and 21/101 (20.8%) in Group 2. When compared to the case of no diverticulum existence (Group 1: 9/163 [5.5%], Group 2: 32/614 [5.2%]), the recurrence rate of CBD stone was significantly lower if treated after EPLBD with minor EST (p<0.01). CONCLUSIONS: CBD stone that recurs after going through EPLBD with minor EST can be successfully removed with an endoscopic treatment. The recurrence of CBD stone was especially lower in cases with periampullary diverticulum and treated with EPLBD with minor EST. Our results will be helpful in endoscopic retreatment and preventing the recurrence of CBD stone.

The Efficacy of Early Scheduled Follow-Up Endoscopic Retrograde Cholangiopancreatography after Common Bile Duct Stone Removal

BACKGROUND/AIMS: To investigate the efficacy of early scheduled follow-up endoscopic retrograde cholangiopancreatography (ERCP) after common bile duct (CBD) stone removal. METHODS: Patients who underwent endoscopic CBD stone removal and who had at least one risk factor for stone recurrence were enrolled. Six months after complete clearance of the CBD, patients underwent follow-up ERCP at an ambulatory care center, irrespective of symptoms. RESULTS: The incidence of symptoms and cholangitis at follow-up ERCP was significantly lower in Group A (ERCP at 6 months after stone removal) than that in Group B (ERCP at >6 months) (14.3% vs 71.4%, p=0.00; 9.5% vs 33.3%, p=0.02, respectively). However, the recurrence rates of CBD stones were not different between Groups A and B (33.3% vs 47.6%). When comparing the subgroups, Group AR (stone recurrence in Group A) displayed significantly fewer symptoms and lesser cholangitis and spent fewer days in the hospital than did Group BR (stone recurrence in Group B) (21.4% vs 70%, p=0.02; 14.3% vs 60%, p=0.02; 2.43+/-1.87 vs 6.10+/-3.35, p=0.00, respectively). CONCLUSIONS: Our data suggest that, irrespective of symptoms, early scheduled follow-up ERCP for patients who are at a high risk of recurrence is effective and safe.

Fluoroscopy guided laser lithotripsy for difficult bile duct stones / 中华消化内镜杂志

Objective To evaluate the efficacy and safety of fluoroscopy guided frequency-doubled double-pulsed laser lithotripsy for removing difficult bile duct stones. Methods From March 2008 to December 2009, patients with difficult bile duct stones were divided into cholangioscopy guided group ( n = 21 )and fluoroscopy guided group ( n = 19) to receive corresponding treatments. The success rate of complete stone removal and the complication rate related to the procedure were compared between the two groups.Results There are no significant differences between 2 groups in regarding of either success rate of complete stone removal ( 19/21, 90. 5% in cholangioscopy guided group vs. 17/19, 89. 5% in fluoroscopy guided group, P ＞0. 05 ) or rate of procedure related complication (4/21, 19. 0% in cholangioscopy guided group vs. 3/19, 15. 8% in fluoroscopic guided group, P = 0. 559 ). Conclusion Frequency-doubled doublepulsed laser lithotripsy guided by cholangioscopy or fluoroscopy are both safe and effective.

Laparoscopic common bile duct exploration for elderly patients: as a first treatment strategy for common bile duct stones / 대한외과학회지

PURPOSE: Common bile duct (CBD) stone is a relatively common disease in elderly patients. There have been many reports about the efficacy and safety of LCBDE. But for elderly patients, only a few studies about its efficacy and safety exist. The aim of this study is to evaluate the efficacy, safety and the surgical outcome of LCBDE in patients who are 70 years or older and compare the results with those of the younger group. METHODS: From January 2000 to November 2009, 132 patients underwent LCBDE. We divided these patients into two groups according to age and conducted a retrospective analysis. The elderly group included patients who were 70 years old or older (n = 64), and the younger group included those who were younger than 70 (n = 68). The elderly group was compared to the younger group with respect to their clinical characteristics, operation time, postoperative hospital stay, open conversion rate, first meal time, postoperative complication, recurrence rate and mortality. RESULTS: The elderly group showed high American Society of Anesthesiologists score (2.2 vs. 1.9) (P = 0.003), preoperative morbidity (47 vs. 29) (P 0.05). CONCLUSION: LCDBE is a safe and effective treatment modality for CBD stones not only for younger patients but also for elderly patients.

Endoscopic sphincterotomy plus balloon dilation for difficult bile duct stones / 中华消化内镜杂志

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.