Comparison between endoscopic sphincterotomy and endoscopic papillary balloon dilation in treatment of extrahepatic bile duct stones / 第二军医大学学报

ABSTRACT

Objective To compare endoscopic sphincterotomy (EST) and endoscopic papillary balloon dilation (EPBD) in treating extrahepatic bile duct stones in terms of similarities and differences. Methods The clinical data of 277 patients with extrahepatic bile duct stones, who were treated from August 2009 to July 2011 in gastroenterology department of Shanghai Changhai Hospital, were retrospectively analyzed, with 168 patients receiving EST and 109 receiving EPBD. The general condition, stone diameter, stone extraction method, operation time, stone-free rate by single procedure, postoperative hospital stay and short-term complications were compared between EST group and EPBD group. Results There were no significant differences in the age, sex ratio, or combination with duodenal diverticulum between the two groups.The mean diameters of the stones were not significantly different between the two groups ([11.3±6.2] mm in EST group vs [10.1±5.7] mm in EPBD group, P=0.105 6). There was no significant difference in the proportions of different stone extraction methods between EST group and EPBD group. The operation time, stone-free rate by single procedure, postoperative hospital stay, and total incidence of short-term complications in EST group were (21.2±3.1)min, 95.2%, (4.1±1.9) d, and 10.1%, and those in EPBD group were (20.7±2.5) min, 94.5%, (4.1±2.0) d, and 12.8%, respectively; with no significant differences found between the two groups (all P>0.05). The incidence of hemorrhage in EST group was significantly higher than that in the EPBD group (3.6% vs 0%, P<0.05). The incidence of hyperamylasemia in EPBD group was significantly higher than that in the EST group (8.3% vs 2.4%, P<0.05). Conclusion EST and EPBD each have their own advantages and disadvantages in the treatment of extrahepatic bile duct stones. Operation mode should be chosen according to the specific condition of patients, but not the size of the stones.