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Objective To evaluate the curative effect and prognosis of endoscopic papillary large balloon dilatation ( EPLBD) in the treatment of choledocholithiasis. Methods A total of 153 patients with choledocholithiasis (>1. 0 cm in stone diameter) admitted and treated in Shanxi People's Hospital from August 2016 to November 2017 were randomly divided into two groups according to the random number table: the EPLBD group ( n=83) and the small endoscopic sphincterotomy plus large balloon dilatation ( ESLBD) group ( n=70) . The success rate of stone removal, the rate of lithotripsy, and the incidence of short-term and long-term complications were compared between the two groups. Results There were no statistical differences between the EPLBD group and the ESLBD group in total stone removal rate [ 95. 2％( 79/83) VS 97. 1％ ( 68/70) ,χ2=0. 388, P=0. 533] and one-time stone removal rate [ 92. 8％ ( 77/83) VS 90. 0％ ( 63/70) ,χ2=0. 375, P=0. 540] . The lithotripsy rate between the two groups had no statistical difference [ 25. 3％ ( 21/83 ) VS 35. 7％ ( 25/70 ) , χ2 = 1. 958, P= 0. 162 ] . There was no statistical difference in the incidence of recent complications between the two groups [ 43. 4％ ( 36/83 ) VS 40. 0％(28/70), χ2=0. 178, P=0. 673]. No postoperative perforation was found in either group. The follow-up time was 22. 7 ± 4. 3 months in the EPLBD group, and 20. 8 ± 6. 3 months in the ESLBD group. The cumulative recurrent rate of choledocholithiasis in the two groups were 2. 4％ ( 2/83) and 15. 7％ ( 11/70) , respectively, and the difference was significant ( P=0. 003) . Conclusion Simple EPLBD in the treatment of choledocholithiasis is equivalent to ESLBD in the success rate of stone removal, utilization rate of lithotripsy, and incidence of recent complications, but the long-term stone recurrence rate of EPLBD is lower than that of ESLBD. EPLBD is effective and safe on the treatment of choledocholithiasis.
ABSTRACT
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.
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BACKGROUND/AIMS: Recurrence is an important late complication of endotherapy of bile duct stones. Endoscopic papillary large balloon dilation (EPLBD) can be used as an alternative method of removing difficult bile duct stones. The aim of this study was to evaluate short term clinical outcomes after removing common bile duct (CBD) stones using EPLBD. METHODS: A retrospective review was performed based on the medical records of 141 patients who received EPLBD, with or without endoscopic sphincterotomy, between September 2008 and February 2010. Of these, 50 patients, were enrolled in the study. Clinical and endoscopic parameters were analyzed to identify risk factors for CBD stones recurrence. RESULTS: Male:Female ratio was 22:28 (mean age, 67.4+/-14.4 years). Recurrence rate was 24.0% (12/50). Mean follow-up period was 10.8+/-4.5 months. Nineteen (38.0%) had a history of surgery and 20 (40.0%) were comorbid with periampullary diverticula. Mean diameters of the stones and CBD were 13.8+/-4.3 mm and 20.1+/-7.2 mm, respectively. In univariate analysis, large CBD stones (> or =12 mm) and angulated CBD (angle < or =145degrees) were identified as the significant predictors of recurrence. In multivariate analysis, angulated CBD (angle < or =145degrees) was the significant independent risk factor for recurrence. CONCLUSIONS: Close follow-up seems necessary in patients with angulated CBD (angle < or =145degrees).
Subject(s)
Humans , Bile Ducts , Common Bile Duct , Dilatation , Diverticulum , Follow-Up Studies , Medical Records , Multivariate Analysis , Recurrence , Retrospective Studies , Risk Factors , Sphincterotomy, EndoscopicABSTRACT
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.
ABSTRACT
In retrieving bile duct stones, full-endoscopic sphincterotomy (EST) with endoscopic mechanical lithotripsy (EML) is considered as a traditional method, and balloon dilation of the papillary sphincter has also been used. Recent studies have reported that mid-EST and endoscopic papillary large balloon dilatation (EPLBD) was as useful as full-EST with EML, without serious complications. In patients with coagulopathy, such as end-stage renal disease, even a small incision of the sphincter could cause profuse bleeding. In such patients, balloon dilation of the sphincter is a preferred technique over EST. A prior Billroth-II operation renders EST more difficult and increases the risk of a complication. In these patients, the use of EPBD is also preferred as well. We report a case of successfully retrieving large bile duct stones by EPLBD without EST, in a patient who had a prior Billroth-II operation, and is undergoing hemodialysis. The patient is free of complications, such as bleeding or acute pancreatitis.