X. Chu, H. Zhang, R. Qu, G. Huang and C. Guo are co-first authors who contributed equally to this study.
To compare the effectiveness and safety of the combination of endoscopic papillary large-balloon dilation (EPLBD) and small endoscopic sphincterotomy (SEST) with either EST or EPLBD alone in the treatment of large bile duct stones.
A total of 127 patients with large bile duct stones were enrolled and randomly divided into four treatment groups (the SEST + EPLBD group, the EPLBD + SEST group, the EST group, and the EPLBD group) in a 1:1:1:1 ratio. Evaluation variables included the success rates of complete stone removal, complete stone removal without the use of endoscopic mechanical lithotripsy (EML), and complete stone removal in one session, as well as the occurrence of short- and long-term postoperative complications.
The overall rate of stone clearance was quite similar among the four treatment groups. There was no significant difference in the rate of complete stone removal without the use of EML among these groups. However, the combination treatment groups required relatively fewer sessions than did the EPLBD group. The incidence rates of short- and long-term complications were relatively lower in the two combination groups than in the EST and EPLBD groups.
A combination of SEST and EPLBD appears to be safe and effective for patients with large bile duct stones. This combination may have potential safety advantages in comparison with EST or EPLBD alone.