Endoscopic large-balloon dilation alone versus endoscopic sphincterotomy plus large-balloon dilation for the treatment of large bile duct stones

Jae Chul Hwang, Jin Hong Kim, Sun Gyo Lim, Soon Sun Kim, Sung Jae Shin, Kee Myung Lee, Byung Moo Yoo, Jae Chul Hwang, Jin Hong Kim, Sun Gyo Lim, Soon Sun Kim, Sung Jae Shin, Kee Myung Lee, Byung Moo Yoo

Abstract

Background: Endoscopic sphincterotomy (EST) combined with large-balloon dilation (LBD) has been proposed as an alternative to manage large bile duct stones. However, recent reports indicate that LBD without EST may be safe and effective in this setting.

Methods: One hundred thirty-one patients with large common bile duct (CBD) stones 12 mm in size or larger underwent LBD alone (n=62) or EST plus LBD (n=69) for lithotripsy. The therapeutic outcome and complications were reviewed and compared.

Results: There were no differences between the two groups with regard to age, size and number of stones, or bile duct diameter. The LBD alone group (mean age, 70.4 years) and the EST plus LBD group (mean age, 68.2 years) had similar outcomes in terms of overall successful stone removal (96.8% vs. 95.7%, P=0.738) and complete stone removal without the need for mechanical lithotripsy (80.6% vs. 73.9%, P=0.360). Complications in the LBD alone and EST plus LBD groups were as follows: pancreatitis (6.5% vs. 4.3%, P=0.593), impaction of basket and stone (0% vs. 1.4%, P=0.341), and perforation (0% vs. 1.4%, P=0.341).

Conclusions: LBD alone may be a simple, safe, and effective alternative to EST plus LBD in relatively aged patients with large CBD stones, and it can simplify the procedure compared with EST plus LBD.

Figures

Figure 1
Figure 1
Endoscopic view of large-balloon dilation without biliary sphincterotomy. A. Guidewire positioned across the papilla. B. Large balloon inflated across the papilla without preceding endoscopic sphincterotomy. C. Markedly dilated papilla after large-balloon dilation. D. Large stone extracted with a basket through the dilated papilla.
Figure 2
Figure 2
Fluoroscopic view of large-balloon dilatation without biliary sphincterotomy. A. Cholangiogram demonstrating a large stone within the dilated bile duct. B. Large balloon inflated across over guidewire. The diameter of the balloon was selected according to the diameter of the stone and of the bile duct proximal to the tapered segment under fluoroscopic guidance. C. The stone was captured in a basket. D. Cholangiogram after complete stone removal showed no residual filling defect in the bile duct.

References

    1. Mathuna PM, White P, Clarke E, Merriman R, Lennon JR, Crowe J. Endoscopic balloon sphincteroplasty (papillary dilation) for bile duct stones: efficacy, safety, and follow-up in 100 patients. Gastrointest Endosc. 1995;42:468–474. doi: 10.1016/S0016-5107(95)70052-8.
    1. Minami A, Nakatsu T, Uchida N, Hirabayashi S, Fukuma H, Morshed SA, Nishioka M. Papillary dilation vs sphincterotomy in endoscopic removal of bile duct stones. A randomized trial with manometric function. Dig Dis Sci. 1995;40:2550–2554. doi: 10.1007/BF02220440.
    1. Sato H, Kodama T, Takaaki J, Tatsumi Y, Maeda T, Fujita S, Fukui Y, Ogasawara H, Mitsufuji S. Endoscopic papillary balloon dilatation may preserve sphincter of Oddi function after common bile duct stone management: evaluation from the viewpoint of endoscopic manometry. Gut. 1997;41:541–544. doi: 10.1136/gut.41.4.541.
    1. Yasuda I, Tomita E, Enya M, Kato T, Moriwaki H. Can endoscopic papillary balloon dilation really preserve sphincter of Oddi function? Gut. 2001;49:686–691. doi: 10.1136/gut.49.5.686.
    1. Lin CK, Lai KH, Chan HH, Tsai WL, Wang EM, Wei MC, Fu MT, Lo CC, Hsu PI, Lo GH. Endoscopic balloon dilatation is a safe method in the management of common bile duct stones. Dig Liver Dis. 2004;36:68–72. doi: 10.1016/j.dld.2003.09.014.
    1. Fujita N, Maguchi H, Komatsu Y, Yasuda I, Hasebe O, Igarashi Y, Murakami A, Mukai H, Fujii T, Yamao K, Maeshiro K. Endoscopic sphincterotomy and endoscopic papillary balloon dilatation for bile duct stones: A prospective randomized controlled multicenter trial. Gastrointest Endosc. 2003;57:151–155. doi: 10.1067/mge.2003.56.
    1. 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. doi: 10.1111/j.1572-0241.2004.30151.x.
    1. Disario JA, Freeman ML, Bjorkman DJ, Macmathuna P, Petersen BT, Jaffe PE, Morales TG, Hixson LJ, Sherman S, Lehman GA, Jamal MM, Al-Kawas FH, Khandelwal M, Moore JP, Derfus GA, Jamidar PA, Ramirez FC, Ryan ME, Woods KL, Carr-Locke DL, Alder SC. Endoscopic balloon dilation compared with sphincterotomy for extraction of bile duct stones. Gastroenterology. 2004;127:1291–1299. doi: 10.1053/j.gastro.2004.07.017.
    1. 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. doi: 10.1067/mge.2003.52.
    1. Heo JH, Kang DH, Jung HJ, Kwon DS, An JK, Kim BS, Suh KD, Lee SY, Lee JH, Kim GH. Endoscopic sphincterotomy plus large-balloon dilation versus endoscopic sphincterotomy for removal of bile-duct stones. Gastrointest Endosc. 2007;66:720–726. doi: 10.1016/j.gie.2007.02.033.
    1. Maydeo A, Bhandari S. Balloon sphincteroplasty for removing difficult bile duct stones. Endoscopy. 2007;39:958–961. doi: 10.1055/s-2007-966784.
    1. Minami A, Hirose S, Nomoto T, Hayakawa S. Small sphincterotomy combined with papillary dilation with large balloon permits retrieval of large stones without mechanical lithotripsy. World J Gastroenterol. 2007;13:2179–2182.
    1. Attasaranya S, Cheon YK, Vittal H, Howell DA, Wakelin DE, Cunningham JT, Ajmere N, Ste Marie RW Jr, Bhattacharya K, Gupta K, Freeman ML, Sherman S, McHenry L, Watkins JL, Fogel EL, Schmidt S, Lehman GA. Large-diameter biliary orifice balloon dilation to aid in endoscopic bile duct stone removal: a multicenter series. Gastrointest Endosc. 2008;67:1046–1052. doi: 10.1016/j.gie.2007.08.047.
    1. Jeong S, Ki SH, Lee DH, Lee JI, Lee JW, Kwon KS, Kim HG, Shin YW, Kim YS. Endoscopic large-balloon sphincteroplasty without preceding sphincterotomy for the removal of large bile duct stones: a preliminary study. Gastrointest Endosc. 2009;70:915–922. doi: 10.1016/j.gie.2009.04.042.
    1. Chan HH, Lai KH, Lin CK, Tsai WL, Wang EM, Hsu PI, Chen WC, Yu HC, Wang HM, Tsay FW, Tsai CC, Chen IS, Chen YC, Liang HL, Pan HB. Endoscopic papillary large balloon dilation alone without sphincterotomy for the treatment of large common bile duct stones. BMC Gastroenterol. 2011;11:69–74. doi: 10.1186/1471-230X-11-69.
    1. Cotton PB, Lehman G, Vennes J, Geenen JE, Russell RC, Meyers WC, Liguory C, Nickl N. Endoscopic sphincterotomy complications and their management: an attempt at consensus. Gastrointest Endosc. 1991;37:383–393. doi: 10.1016/S0016-5107(91)70740-2.
    1. Binmoeller KF, Bruckner M, Thonke F, Soehendra N. Treatment of difficult bile duct stones using mechanical, electrohydraulic and extracorporeal shock wave lithotripsy. Endoscopy. 1993;25:201–206. doi: 10.1055/s-2007-1010293.
    1. Cipolletta L, Costamagna G, Bianco MA, Rotondano G, Piscopo R, Mutignani M, Marmo R. Endoscopic mechanical lithotripsy of difficult common bile duct stones. Br J Surg. 1997;84:1407–1409. doi: 10.1002/bjs.1800841019.
    1. Binmoeller KF, Schafer TW. Endoscopic management of bile duct stones. J Clin Gastroenterol. 2001;32:106–118. doi: 10.1097/00004836-200102000-00004.
    1. Ando T, Tsuyuguchi T, Okugawa T, Saito M, Ishihara T, Yamaguchi T, Saisho H. Risk factors for recurrent bile duct stones after endoscopic papillotomy. Gut. 2003;52:116–121. doi: 10.1136/gut.52.1.116.
    1. Bang S, Kim MH, Park JY, Park SW, Song SY, Chung JB. Endoscopic papillary balloon dilation with large balloon after limited sphincterotomy for retrieval of choledocholithiasis. Yonsei Med J. 2006;47:805–810. doi: 10.3349/ymj.2006.47.6.805.
    1. Kim TH, Oh HJ, Lee JY, Sohn YW. Can a small endoscopic sphincterotomy plus a large-balloon dilation reduce the use of mechanical lithotripsy in patients with large bile duct stones? Surg Endosc. 2011;25:3330–3337. doi: 10.1007/s00464-011-1720-3.
    1. Laugier R, Bernard JP, Berthezene P, Dupuy P. Changes in pancreatic exocrine secretion with age: pancreatic exocrine secretion does decrease in the elderly. Digestion. 1991;50:202–211. doi: 10.1159/000200762.
    1. Weinberg BM, Shindy W, Lo S. Endoscopic balloon sphincter dilation (sphincteroplasty) versus sphincterotomy for common bile duct stones. Cochrane Database Syst Rev. 2006;18:CD004890.

Source: PubMed

스폰서 및 공동 작업자

건강 상태

약물 개입

3
구독하다