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

Kim, Tae Hyeon; Oh, Hwa-Suk; Lee, Jun Young; Sohn, Young Woo

doi:10.1007/s00464-011-1720-3

Cited by 88 publications

(107 citation statements)

References 21 publications

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“…Although a priori removal of the stones proved more difficult in the ES with SP group, the success rate was similar in both cases (94% in the ES with SP group versus 97% in the ES group) and consistent with the findings of other studies [13,14,16,17,19,21,22]. Likewise, no differences were observed between the two groups in terms of complications.…”

Section: Discussionsupporting

confidence: 90%

“…In our series, the global mortality rate was 3.28%, and was only slightly higher in the ES with SP group (3.8%) than in the ES group (2.7%)-with no significant differences between them. Our complication rate was somewhat lower than in other studies [13,14,16,17,22]. The incidence of acute pancreatitis was practically identical in both groups (1.9% in the ES with SP group versus 2% in the ES group), and in no case did we use pancreatic stents.…”

Section: Discussioncontrasting

confidence: 47%

“…Martín-Arranz maintains insufflation during one minute [9], while other authors limit this time to between 15 -30 seconds [13,17]. Most studies, including our own, use balloon diameters of between 10 and 20 mm [6,9,11,13,[17][18][19][20], and in abidance with our own practice, it is generally advised not to exceed the diameter of the biliary tract [11].…”

Section: Discussionmentioning

confidence: 99%

“…Most studies, including our own, use balloon diameters of between 10 and 20 mm [6,9,11,13,[17][18][19][20], and in abidance with our own practice, it is generally advised not to exceed the diameter of the biliary tract [11]. We indistinctly use Fogarty balloons or Dormia baskets, and sometimes combine both devices.…”

Section: Discussionmentioning

confidence: 99%

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Efficacy and safety of sphincterotomy with sphincteroplasty using large caliber balloons in the treatment of choledocholithiasis with extraction difficulties

Uribarrena-Amezaga¹,

Serna²,

Calvo-Morillas³

et al. 2013

OJGas

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Introduction: Endoscopic retrograde cholangiopancreatography (ERCP) with endoscopic sphincterotomy (ES) is the most widely used technique for treating choledocholithiasis.In some cases, due to anomalies of the papilla or the presence of large or multiple calculi, additional maneuvers are needed to remove the stones. The present study investigates the efficacy and safety of ES with sphincteroplasty (SP) in the management of choledocholithiasis with extraction difficulties. Patients and Methods: A prospective study was made of 153 patients with choledocholithiasis subjected to ERCP. Fifty-two patients underwent ES with SP, while 101 were subjected only to ES. The two groups were compared in terms of age, gender, percentage cannulation, presence of papilla alterations, large or multiple stones, success in stone removal and complications (acute pancreatitis, bleeding and perforation). In the ES with SP group, we moreover recorded the diameters of the balloons employed (10 -18 mm). Results: There were no significant differences between the groups in the stone extraction success rate (94.23% in the ES with SP group versus 97.03% in the ES group) or in the appearance of complications (3.8% in the ES with SP group versus 2.7% in the ES group). The presence of difficult papillae, and of multiple or large stones was significantly greater in the ES with SP group. The diameter of the balloon was not associated with the appearance of complications. Conclusion: Endoscopic sphincterotomy with sphincteroplasty is effective and safe in the treatment of choledocholithiasis with extraction difficulties.

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Section: Discussionsupporting

confidence: 90%

Section: Discussioncontrasting

confidence: 47%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Efficacy and safety of sphincterotomy with sphincteroplasty using large caliber balloons in the treatment of choledocholithiasis with extraction difficulties

Uribarrena-Amezaga¹,

Serna²,

Calvo-Morillas³

et al. 2013

OJGas

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“…Dans notre étude, la clairance de la VBP était de 91,6%et nos résultats étaient comparables à ceux rapportésd ans la littérature. Deux études rétrospectives ont comparé les taux de succès de la SE et de la SMSO.E lles ont montré un taux d'extraction de calcul significativement plus élevésa près( SMSO) qu'aprèsS E( 84,2 %v s4 4,2 %, p<0,001 [16] et 87,5 %v s7 4,0 %, p=0,036 [17]). Dansl ap lupart des études, le recours à une LM aprèsS MSO est réduit par rapport à la SE [18].…”

Section: Patients Et Méthodesunclassified

La SMSO (Sphinctérotomie avec macrodilatation du sphincter d’Oddi) dans le traitement des gros calculs de la voie biliaire principale : Expérience de l’Hôpital Militaire de Rabat (Maroc)

Hassan¹,

Chakkor²,

Berrag³

et al. 2017

Hegel

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RésuméAprèss phinctérotomie endoscopique, prèsd e1 0%desl ithiases de la voie biliaire principale restent inextirpables en cas de gros calculs ou empierrements cholédociens. Le recours à la lithotritie mécanique est alors nécessaire mais cette technique est coûteuse, augmente la durée de procédure et de succèsi nconstant.Objectif : L'objectif principal est d'évaluer l'efficacité et l'innocuité de la SMSO ou sphinctéroplastie pour l'extraction de macro calculs de la voie biliaire principale. Les objectifs secondaires sont d'analyser les facteurs associésausuccès de cette technique ainsi que d'évaluer rétrospectivement le taux de lithotritiem é canique évité. Patients et Méthodes :Etude rétrospectived ej anvier 2008 au janvier 2017 incluant tous les patients qui avaient bénéficié d'une SMSO pour extraction endoscopique de macro calculs de la voie biliaire principale définis par un diamètre ≥ 15 mm. Le succès de la SMSO était défini par l'absence de calcul résiduel en findeprocédure. Les facteurs associés étudiés(âge, sexe, diamètre de la voie biliaire principale, nombre de calculs, présence d'une angiocholite, disparité de calibre du cholédoque, notion d'une sphinctérotomie antérieure)o nt été analyséss elon un modèle de régression logistique binaire.Résultats : Ont été inclus quarante-huit patients (28 femmes et 20 hommes), d'âge moyen 63,5 ± 12 ans. Une vacuité complète de la voie biliaire principale a été obtenue sans recours à une lithotritie mécanique dans 44/48 cas soit 91,6 %. L'extraction s'est révéléei mpossible chez 4c as ayant des macro calculs dont le diamètrem oyen était de 19 ± 2m m. Deux cas avaient bénéficié d'une pose de prothèse biliaire plastique alors que les deux autres ont été traitéschirurgicalement. Le taux de complication était de 6,2 %s ous forme d'un saignement minime des berges jugulé par compression pneumatique chez 3/48 cas. En analyse univariée, seul le sexesemble être un facteur associé (p=0,03, OR=0,05, IC 95% [0,03-0,77]), tandis qu'en analyse multivariée, aucune des variables étudiées ne semble être un facteur d'échec ou de succèsd el as phinctéroplastie.Conclusion : La macrodilatation du sphincter d'Oddi après sphinctérotomie est une technique simple efficace et sûre pour l'extraction endoscopique de gros calculs cholédociens en évitant une lithotritie mécanique dans 91,6 %d es cas. Dans notre série, aucun facteur étudié ne semble être associéàson échec ou succès. Mots-clés

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Comparison of endoscopic papillary large‐balloon dilatation with endoscopic sphincterotomy in clearing large common bile duct stones: A systematic review and meta‐analysis of randomized controlled trials

Cheng

Tang

Cheng

et al. 2022

Adv in Digestive Medicine

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There are three methods to retrieve large common bile duct stones, the first is endoscopic sphincterotomy (EST), the second is endoscopic papillary large‐balloon dilatation (EPLBD), and the third is limited EST plus EPLBD. Although EST is the most popularly used method, it has higher risk of bleeding complication and basket stuck. EPLBD alone without EST demonstrated safe and quick in the clinical practice, but there were only few studies focused on comparing EST or EPLBD alone. Thus, this study aims to compare the efficacy and safety of EPLBD with EST. We searched for PubMed, Embase, and Cochrane Library databases to collect relevant articles until August 31st, 2019. We included randomized controlled trials, common bile duct stones > 10 mm, comparison of endoscopic papillary large‐balloon dilatation with endoscopic sphincterotomy, and patients older than 18. We compare endoscopic papillary large‐balloon dilatation with endoscopic sphincterotomy on the clearance of large common bile duct stones, the adverse events, and the need for mechanical lithotripsy. This systematic review and meta‐analysis was registered on PROSPERO and the registration number is CRD42020150485. Total six studies met inclusion criteria and 762 participants were enrolled. The data revealed that endoscopic papillary large‐balloon dilatation alone was comparable to endoscopic sphincterotomy on the clearance of large common bile duct stones (RR = 1.02, 95% CI: 0.93‐1.12), the adverse events (RR = 1.01, 95% CI: 0.71‐1.43) and the need for mechanical lithotripsy. In the subgroup analysis, the requirement of mechanical lithotripsy decreased in the non‐Chinese group (RR = 0.58, 95% CI: 0.41‐0.84). The efficacy and safety to clean large common bile duct stones are comparable in either EPLBD or EST. In addition, EPLBD alone not only saves the operation time but also reduces the chance of mechanical lithotripsy in the subgroup analysis.

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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?

Abstract: 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.

Cited by 88 publications

References 21 publications

Efficacy and safety of sphincterotomy with sphincteroplasty using large caliber balloons in the treatment of choledocholithiasis with extraction difficulties

Efficacy and safety of sphincterotomy with sphincteroplasty using large caliber balloons in the treatment of choledocholithiasis with extraction difficulties

La SMSO (Sphinctérotomie avec macrodilatation du sphincter d’Oddi) dans le traitement des gros calculs de la voie biliaire principale : Expérience de l’Hôpital Militaire de Rabat (Maroc)

Comparison of endoscopic papillary large‐balloon dilatation with endoscopic sphincterotomy in clearing large common bile duct stones: A systematic review and meta‐analysis of randomized controlled trials

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