Comparison of the usefulness of endoscopic papillary large-balloon dilation with endoscopic sphincterotomy for large and multiple common bile duct stones

Tsuchida, Kouhei; Iwasaki, Mari; Tsubouchi, Misako; Suzuki, Tsunehiro; Tsuchida, Chieko; Yoshitake, Naoto; Sasai, Takako; Hiraishi, Hideyuki

doi:10.1186/s12876-015-0290-6

Cited by 15 publications

(13 citation statements)

References 30 publications

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“…In our study, both EST and EPLBD alone for management of bile duct stones resulted in similar outcomes with respect to complete stone clearance (100% versus 99.4%), which is similar to previous results regarding overall stone clearance [ 12 , 21 , 22 ]. In addition, ML might be used more often in the EST group compared to the EPLBD group for removal of large or multiple stones in our study (17 [28.3%] versus 29 [18%]).…”

Section: Discussionsupporting

confidence: 90%

Comparison of the Long-Term Outcomes of Endoscopic Papillary Large Balloon Dilation Alone versus Endoscopic Sphincterotomy for Removal of Bile Duct Stones

Wen

Bie

et al. 2018

Gastroenterology Research and Practice

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Background and Aims Endoscopic papillary large balloon dilation (EPLBD) alone is an alternative to endoscopic sphincterotomy (EST) for treatment of common bile duct (CBD) stones. However, limited data exists regarding comparison of the long-term outcomes for these techniques. In this study, we compared the long-term outcomes after EST with those after EPLBD alone for removal of CBD stones. Methods The records of patients with EST or EPLBD alone referred for CBD stones retrieval between June 2008 and July 2015 were retrospectively reviewed. Complete stone clearance, ERCP-related adverse events, and late biliary complications during long-term follow-up were analyzed. Results Basic patient characteristics were similar between the groups that underwent EST (n = 60) and EPLBD alone (n = 161). EPLBD compared with EST resulted in similar outcomes in terms of complete stone clearance (99.4% versus 100%, P = 0.54) and ERCP-related adverse events (6.8% versus 6.7%, P = 1.00). The mean duration of the follow-up was 74.5 months and 71.6 months who underwent EST and EPLBD alone, respectively (P = 0.42). Late biliary complications were occurred frequently in the EST group than in the EPLBD alone group (11 [18.6%] versus 16 [10.2%]), although the difference did not reach statistical significance (P = 0.11). Multivariate analysis showed that mechanical lithotripsy ([OR], 2.815; 95% CI, 1.148–6.902; P = 0.024) was significantly associated with late biliary complications. Conclusion As an alternative to EST, EPLBD has similar efficacy and safety for managing CBD stones. During long-term follow-up, patients who underwent EPLBD alone may have fewer late biliary complications compared with those after EST. In addition, mechanical lithotripsy may be an independent risk factor for late biliary complications.

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Section: Discussionsupporting

confidence: 90%

Comparison of the Long-Term Outcomes of Endoscopic Papillary Large Balloon Dilation Alone versus Endoscopic Sphincterotomy for Removal of Bile Duct Stones

Wen

Bie

et al. 2018

Gastroenterology Research and Practice

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“…In addition, the success rate of the first-session treatment for ≥10- or ≥ 12-mm bile duct stone removal was 81.4–85% in the EST group [9, 16, 17], 65–89% in the EPLBD group [2, 10, 12, 16, 20, 21], and 71–97% in the EPLBD + EST group [2, 7–10, 17]. In particular, large bile duct stones ≥15 mm yielded an overall success rate of 88.9–100% for stone removal in the EST group, 97.35–100% in the EPLBD group, and 94.4–100% in the EPLBD + EST group [1, 3, 4, 14, 15, 18]. The success rates of the first-session treatment for ≥15-mm bile duct stone removal were 55.6–87% in the EST group, 78–87.87% in the EPLBD group, and 83–88.2% in the EPLBD + EST group [3, 4, 14, 15, 18].…”

Section: Discussionmentioning

confidence: 99%

The efficacy of limited endoscopic sphincterotomy plus endoscopic papillary large balloon dilation for removal of large bile duct stones

et al. 2019

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Background The removal of large bile duct stones (> 15 mm) by conventional endoscopic sphincterotomy (EST) and endoscopic papillary balloon dilation (EPBD) can be challenging, requiring mechanical lithotripsy (ML) in addition to EST or EPBD. The primary complication of ML is basket and stone impaction, which can lead to complications such as pancreatitis and cholangitis. The present study aims to investigate the efficacy of limited EST plus endoscopic papillary large balloon dilation (EST-EPLBD) for large bile duct stone extraction with an extent of cutting < 1/2 the length of the papillary mound. Methods We enrolled 185 patients with ≥15 mm bile duct stones who received EST, EPLBD and limited EST-EPLBD treatment from January 1, 2010 to February 28, 2018, at Kaohsiung Chang Gung Memorial Hospital (Kaohsiung, Taiwan). All patients were categorized into three groups: EST group ( n = 31), EPLBD group ( n = 96), and limited EST-EPLBD group ( n = 58). The primary outcome variables were the success rate of complete stone removal and complications. Results The limited EST-EPLBD group exhibited a higher success rate of the first-session treatment compared with the EST and EPLBD groups (98.3% vs. 83.9% vs. 86.5%; P = 0.032) but required a longer procedure time (32 (12–61) min vs. 23.5 (17–68) min vs. 25.0 (14–60) min; P = 0.001). The need for ML during the procedure was 4 (12.9%) in the EST group, 10 (10.4%) in the EPLBD group and 2 (3.4%) in the limited EST-EPLBD group. Post-procedure bleeding in the EST group was more common than that in the limited EST-EPLBD group (9.7% vs. 0%; P = 0.038). Furthermore, dilated bile duct was the only risk factor for bile duct stone recurrence in the limited EST-EPLBD group. Conclusions Limited EST-EPLBD exhibits a higher success rate but requires marginally longer procedure time for the first-session treatment. Furthermore, dilated bile duct is the only risk factor for bile duct stone recurrence in patients undergoing limited EST-EPLBD.

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“…Although EPLBD was performed recently for patients with large CBDSs, the present study only included 3 patients who underwent EPLBD. Some previous studies reported that EPLBD with EST for large CBDSs was associated with an equal number (or fewer) ERCP-related complications to EST alone ( 7 , 21 ). Based on these previous studies, single-stage endoscopic stone removal with EPLBD may be a safe procedure for the removal of large CBDSs.…”

Section: Discussionmentioning

confidence: 95%

“…In approximately 90% of the cases, endoscopic stone removal is possible following EST and EPBD using a basket or balloon ( 3 , 4 ). For large common bile duct stones (CBDSs), endoscopic stone removal is achieved with a mechanical lithotripter ( 5 , 6 ) or endoscopic large balloon dilation (EPLBD) ( 7 ). Thus, endoscopic stone removal is increasingly used based on the high success rate.…”

Section: Introductionmentioning

confidence: 99%

The Incidence of Complications in Single-stage Endoscopic Stone Removal for Patients with Common Bile Duct Stones: A Propensity Score Analysis

et al. 2018

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Objective Single-stage endoscopic stone removal for choledocholithiasis is an advantageous approach because it is associated with a shorter hospital stay; however, few studies have reported the incidence of complications related to this procedure in detail. The aim of this study was to examine the incidence of complications and efficacy of this procedure. Methods This retrospective study investigated the incidence of complications in 345 patients with naive papilla who underwent therapeutic endoscopic retrograde cholangiopancreatography (ERCP) for choledocholithiasis at three institutions between April 2014 and March 2016 by a propensity score analysis. The efficacy of single-stage endoscopic stone removal was assessed based on a hospital stay of within 7 days and the number of ERCP attempts. Results Among 114 patients who underwent single-stage endoscopic stone removal, 15 patients (13.2%) experienced complications. Among the remaining 231 patients in the two-stage endoscopic stone removal group, complications were observed in 17 patients (7.4%). The propensity score analysis, which was adjusted for confounding factors, revealed that single-stage endoscopic stone removal was not a significant risk factor for complications (p=0.52). In patients in whom >10 min was required for deep cannulation, single-stage endoscopic stone removal was not a significant risk factor for complications in the propensity score analysis (p=0.37). In the single-stage group, the proportion of patients with a hospital stay of within 7 days was significantly higher and the number of ERCP attempts was significantly lower in comparison to the two-stage group (p <0.0001 and <0.0001, respectively). Conclusion Single-stage endoscopic stone removal did not increase the incidence of complications associated with ERCP and was effective for reducing the hospital stay and the number of ERCP attempts.

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Comparison of the usefulness of endoscopic papillary large-balloon dilation with endoscopic sphincterotomy for large and multiple common bile duct stones

Cited by 15 publications

References 30 publications

Comparison of the Long-Term Outcomes of Endoscopic Papillary Large Balloon Dilation Alone versus Endoscopic Sphincterotomy for Removal of Bile Duct Stones

Comparison of the Long-Term Outcomes of Endoscopic Papillary Large Balloon Dilation Alone versus Endoscopic Sphincterotomy for Removal of Bile Duct Stones

The efficacy of limited endoscopic sphincterotomy plus endoscopic papillary large balloon dilation for removal of large bile duct stones

The Incidence of Complications in Single-stage Endoscopic Stone Removal for Patients with Common Bile Duct Stones: A Propensity Score Analysis

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