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Can a small endoscopic sphincterotomy plus a large-balloon dilation reduce the use of mechanical lithotripsy in patients with large bile duct stones?

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Abstract

Background

Endoscopic retrograde cholangiopancreatography (ERCP) with endoscopic sphincterotomy (EST) is technically difficult in the patients with large extrahepaic bile duct stones. Small endoscopic sphincterotomy combined with large-balloon dilation (ESLBD) currently seems to be a promising alternative for patients with difficult bile duct stones that cannot be extracted by EST. This study compared the therapeutic benefits and complication rates of ESLBD with those of EST alone.

Methods

This study investigated 149 patients treated for stones (≥10 mm) or multiple stones in the extrahepatic bile duct. The ESLBD group (n = 72) was compared with the conventional EST group (n = 77). Mechanical lithotripsy was performed when the stone could not be removed using a Dormia basket.

Results

The two groups did not differ significantly in terms of mean bile duct diameter, common bile duct angulation, and presence of periampullary diverticulum. The ESLBD group compared with the EST-alone group had similar outcomes in terms of overall successful stone removal but showed significant differences in complete stone removal during the first session (87.5 vs. 74.0%; P = 0.036) and the use of mechanical lithotripsy for large bile duct stones (≥15 mm) (17.9 vs. 45.8%; P = 0.026). For the patients with a periampullary diverticulum, ESLBD and EST showed similar results only for efficacy and complications.

Conclusions

The ESLBD technique may be a safe, effective alternative to conventional EST for endoscopic removal of large common bile duct stones, and it can reduce the use of mechanical lithotripsy compared with EST alone.

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Acknowledgment

This article was supported by Wonkwang University reseach funds in 2011.

Disclosures

Tae Hyeon Kim, Hyo Jeong Oh, Jun Young Lee, and Young Woo Sohn have no conflicts of interests or financial ties to disclose.

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Authors and Affiliations

  1. Department of Internal Medicine, School of Medicine, Wonkwang University, Iksan, Chonbuk, 570-749, South Korea

    Tae Hyeon Kim, Hyo Jeong Oh, Jun Young Lee & Young Woo Sohn

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  1. Tae Hyeon Kim
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  2. Hyo Jeong Oh
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  3. Jun Young Lee
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Correspondence to Tae Hyeon Kim.

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Kim, T.H., Oh, H.J., Lee, J.Y. et al. 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 25, 3330–3337 (2011). https://doi.org/10.1007/s00464-011-1720-3

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