Abstract
Background
Endoscopic papillary large balloon dilatation (EPLBD) without endoscopic sphincterotomy (EST) is an accepted, simplified endoscopic technique for large common bile duct (CBD) stone removal. However, little is known about the long-term outcomes of this technique. The purpose of this study was to evaluate the long-term outcomes of EPLBD without EST for the treatment of large CBD stones.
Methods
This retrospective study of EPLBD without EST for a large CBD stone was conducted between June 2005 and October 2010. A total of 128 patients with a large CBD stone were included. The primary outcome measurement was complete CBD stone removal after EPLBD. Clinical data obtained from medical records were analyzed.
Results
The overall complete stone removal rate was 94.5 %. Mechanical lithotripsy was needed in 18 (14.1 %) patients. Post-procedural pancreatitis and asymptomatic hyperamylasemia occurred in 1 (0.8 %) and 11 (8.6 %) patients, respectively. One (0.8 %) patient experienced minor bleeding. The rate of stone recurrence was 13.1 %, and median time to stone recurrence was 600 days (range 144–2284 days). Over a half (64.3 %) of stone recurrences occurred during the 2 years following stone removal. Recurrence tended to be more frequent in patients with a large CBD diameter and in patients requiring multiple endoscopic sessions for complete CBD stone retrieval.
Conclusion
EPLBD without EST may be safe and effective in patients with a large bile duct stone.
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References
Bergman JJ, Rauws EA, Fockens P, et al. Randomised trial of endoscopic balloon dilation versus endoscopic sphincterotomy for removal of bileduct stones. Lancet. 1997;349:1124–1129.
Komatsu Y, Kawabe T, Toda N, et al. Endoscopic papillary balloon dilation for the management of common bile duct stones: experience of 226 cases. Endoscopy. 1998;30:12–17.
Mac Mathuna P, White P, Clarke E, et al. Endoscopic balloon sphincteroplasty (papillary dilation) for bile duct stones: efficacy, safety, and follow-up in 100 patients. Gastrointest Endosc. 1995;42:468–474.
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;57:156–159.
Ghazanfar S, Qureshi S, Leghari A, et al. Endoscopic balloon sphincteroplasty as an adjunct to endoscopic sphincterotomy in removing large and difficult bile duct stones. J Pak Med Assoc: JPMA. 2010;60:1039.
Teoh AYB, Cheung FKY, Hu B, et al. Randomized trial of endoscopic sphincterotomy with balloon dilation versus endoscopic sphincterotomy alone for removal of bile duct stones. Gastroenterology. 2013;144:341–345.
Itoi T, Itokawa F, Sofuni A, 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;104:560–565.
Park SJ, Kim JH, Hwang JC, et al. Factors predictive of adverse events following endoscopic papillary large balloon dilation: results from a multicenter series. Dig Dis Sci. 2013;58:1100–1109.
Gregg JA, De Girolami P, Carr-Locke DL. Effects of sphincteroplasty and endoscopic sphincterotomy on the bacteriologic characteristics of the common bile duct. Am J Surg. 1985;149:668–671.
Sand J, Airo I, Hiltunen KM, et al. Changes in biliary bacteria after endoscopic cholangiography and sphincterotomy. Am Surg. 1992;58:324–328.
Jeong S, Ki S, Lee DH, et al. Endoscopic large-balloon sphincteroplasty without preceding sphincterotomy for the removal of large bile duct stones: a preliminary study. Gastrointest Endosc. 2009;70:915–922.
Cotton P, Lehman G, Vennes J, et al. Endoscopic sphincterotomy complications and their management: an attempt at consensus. Gastrointest Endosc. 1991;37:383–393.
Baek YH, Kim HJ, Park JH, et al. Risk factors for recurrent bile duct stones after endoscopic clearance of common bile duct stones. Korean J Gastroenterol. 2009;54:36–41.
Kogure H, Tsujino T, Isayama H, et al. Short-and long-term outcomes of endoscopic papillary large balloon dilation with or without sphincterotomy for removal of large bile duct stones. Scand J Gastroenterol. 2013;49:121–128.
Baron TH, Harewood GC. Endoscopic balloon dilation of the biliary sphincter compared to endoscopic biliary sphincterotomy for removal of common bile duct stones during ERCP: a metaanalysis of randomized, controlled trials. Am J Gastroenterol. 2004;99:1455–1460.
Kim HG, Cheon YK, Cho YD, et al. Small sphincterotomy combined with endoscopic papillary large balloon dilation versus sphincterotomy. World J Gastroenterol. 2009;15:4298–4304.
Youn YH, Lim HC, Jahng JH, et al. The increase in balloon size to over 15 mm does not affect the development of pancreatitis after endoscopic papillary large balloon dilatation for bile duct stone removal. Dig Dis Sci. 2011;56:1572–1577.
Freeman ML, Nelson DB, Sherman S, et al. Complications of endoscopic biliary sphincterotomy. N Engl J Med. 1996;335:909–919.
Omuta S, Maetani I, Saito M, et al. Is endoscopic papillary large balloon dilatation without endoscopic sphincterotomy effective? World J Gastroenterol: WJG. 2015;21:7289.
Kim KY, Han J, Kim HG, et al. 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. Clin Endosc. 2013;46:637–642.
Yasuda I, Tomita E, Enya M, et al. Can endoscopic papillary balloon dilation really preserve sphincter of Oddi function? Gut. 2001;49:686–691.
Hisatomi K, Ohno A, Tabei K, et al. Effects of large-balloon dilation on the major duodenal papilla and the lower bile duct: histological evaluation by using an ex vivo adult porcine model. Gastrointest Endosc. 2010;72:366–372.
Chan H, Lai K, Lin C, et al. Endoscopic papillary large balloon dilation alone without sphincterotomy for the treatment of large common bile duct stones. BMC Gastroenterol. 2011;11:1.
Acknowledgments
This study was supported by an Inha University Hospital Grant.
Authors’ contribution
Jin-Seok Park, MD, contributed to study conception and design, collection and assembly of data, analysis and interpretation of the data, drafting of the article, and provision of study materials or patients. Byung Wook Bang, MD, was involved in collection and assembly of data and provision of study materials or patients. Ae Ra Kang, RN, helped in administrative and technical support. Seok Jeong, MD, and Don Haeng Lee, MD, contributed to study conception and design, critical revision of the article for important intellectual content, administration, and final approval of the article.
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Seok Jeong and Don Haeng Lee have contributed equally to this work and share authorship.
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Park, JS., Jeong, S., Bang, B.W. et al. Endoscopic Papillary Large Balloon Dilatation Without Sphincterotomy for the Treatment of Large Common Bile Duct Stone: Long-Term Outcomes at a Single Center. Dig Dis Sci 61, 3045–3053 (2016). https://doi.org/10.1007/s10620-016-4220-4
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DOI: https://doi.org/10.1007/s10620-016-4220-4