Endoscopic papillary large balloon dilation and endoscopic papillary balloon dilation both without sphincterotomy for removal of large bile duct stones: A propensity‐matched analysis

Hakuta, Ryunosuke; Kawahata, Shuhei; Kogure, Hirofumi; Nakai, Yousuke; Saito, Kei; Saito, Tomotaka; Hamada, Tsuyoshi; Takahara, Naminatsu; Uchino, Rie; Tsujino, Takeshi; Tada, Minoru; Sakamoto, Naoya; Isayama, Hiroyuki; Koike, Kazuhiko

doi:10.1111/den.13220

Cited by 27 publications

(18 citation statements)

References 53 publications

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“…The incidences and causes of recurrent CBDS might be different between EPBD and EST: 17% after EST and 8% after EPBD in one randomized controlled trial . Preserving sphincter of Oddi function, EPBD reportedly improves long‐term outcome compared with EST or EPLBD . Given high rate of EPBD in the current study, the incidence of CBDS recurrence could be low.…”

Section: Discussionmentioning

confidence: 69%

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Multiple recurrences after endoscopic removal of common bile duct stones: A retrospective analysis of 976 cases

Kawaji

Isayama

Nakai

et al. 2019

J of Gastro and Hepatol

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Background and Aim Recurrences after endoscopic treatment of common bile duct stones (CBDS) are common. The aims of this study were to identify risk factors for recurrences of CBDS and to evaluate the effect of interventions for prevention of further recurrences. Methods A total of 976 patients who underwent endoscopic treatment of CBDS were retrospectively studied. Risk factors for single and multiple recurrent CBDS were evaluated using a Cox hazard regression model. The incidences of further recurrences were evaluated according to the additional interventions. Results The mean age was 69.3 years, and 39.3% were female. Endoscopic papillary balloon dilation, endoscopic sphincterotomy, and endoscopic papillary large balloon dilation were performed in 858, 77, and 41 patients, respectively. The rates of one or more recurrence and multiple recurrences of CBDS were 12.4% and 2.7%, respectively. In the multivariate analyses, the significant risk factors were the bile duct size (hazard ratio [HR] 1.07, P = 0.012), gallbladder left in situ with stones (HR 1.91, P = 0.046), and pneumobilia after treatment (HR 2.10, P = 0.047) for single recurrence and the number of stones at the first recurrence (HR 1.16, P = 0.021) for multiple recurrences. In five out of nine cases with multiple recurrences, further recurrence was not observed after additional sphincteroplasty in addition to cholecystectomy. Conclusions The incidence of multiple recurrences was not uncommon after the first recurrence of CBDS.

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Section: Discussionmentioning

confidence: 69%

“…3 Preserving sphincter of Oddi function, EPBD reportedly improves long-term outcome compared with EST or EPLBD. 3,30 Given high rate of EPBD in the current study, the incidence of CBDS recurrence could be low. However, sphincteroplasty was not associated with single and multiple recurrences of CBDS in the multivariate analysis.…”

Section: Discussionmentioning

confidence: 84%

Multiple recurrences after endoscopic removal of common bile duct stones: A retrospective analysis of 976 cases

Kawaji

Isayama

Nakai

et al. 2019

J of Gastro and Hepatol

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“…Although EST with a large incision may be effective to achieve stone clearance and may have a clearance rate similar to that of EPLBD with prior EST for large and/or multiple CBDSs, the former procedure increases the risk of adverse events such as bleeding and perforation and more mechanical lithotripsy (ML) would be required 7. As for EPLBD vs EPBD use in patients with large and/or multiple CBDSs, EPLBD has been proven to require fewer endoscopy sessions and lower frequency of ML usage 8,9…”

Section: Introductionmentioning

confidence: 99%

Comparison of endoscopic papillary large balloon dilation with and without a prior endoscopic sphincterotomy for the treatment of patients with large and/or multiple common bile duct stones: a systematic review and meta-analysis

Liu¹,

Lin

Chen

et al. 2019

TCRM

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AimTo compare endoscopic papillary large balloon dilation (EPLBD) alone with EPLBD following endoscopic sphincterotomy (EST) in patients with large and/or multiple common bile duct stones.MethodsWe conducted a comprehensive search of PubMed, EMBASE, and the Cochrane Library database to identify relevant available articles until July 19, 2018. Complete common bile duct stone (CBDS) removal rate, frequency of mechanical lithotripsy (ML) usage, total procedure time and intra- and postoperative adverse events were analyzed. We used RevMan 5.3 to perform the pooled analyses.ResultsSeven RCTs matched the selection criteria. A total of 369 patients underwent EPLBD alone, and 367 patients underwent EPLBD following EST. Our meta-analysis revealed that there were no significant differences in terms of initial success rate (OR =0.69, 95% CI=0.44–1.09, P=0.11), frequency of ML usage (OR =1.18, 95% CI=0.68–2.05, P=0.55), rate of post-endoscopy pancreatitis (PEP) (OR =0.88, 95% CI=0.43–1.78, P=0.72), total procedure time (MD =1.52, 95% CI=-0.13–3.17, P=0.07), or other intra- and postoperative adverse events between the groups for patients with large and/or multiple CBDSs.ConclusionsEPLBD alone was comparable to EPLBD with prior EST in patients with large and/or multiple CBDSs. Further studies are required to confirm the mechanisms of PEP in patients who accept EPLBD during endoscopic retrograde cholangiopancreatography (ERCP).

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“…Biliary or pancreatic cannulation was attempted via wire-guided or contrast-assisted method using a cannula (MTW Endoskopie, Wesel, Germany) or sphincterotome (Truetome, Boston Scientific Japan, Tokyo, Japan) and a 0.025-inch guidewire (VisiGlide2, Olympus, Tokyo, Japan; Endoselector, Boston Scientific Japan). Sphincteroplasty (endoscopic papillary balloon dilation [EPBD] or endoscopic papillary large balloon dilation [EPLBD] without sphincterotomy) using a balloon catheter (Hurricane RX or CRE wire-guided balloon dilator, Boston Scientific Japan; ZARA or GIGA2, Century Medical, Tokyo, Japan) was performed before stone extraction for patients with intact papilla, as previously reported 25 26 27 . Basket (TetraCatch V and FlowerBasket V, Olympus) and/or balloon catheters (Multi-3V Extraction Balloon, Olympus) were used for the removal of bile duct stones 28 .…”

Section: Methodsmentioning

confidence: 99%

Feasibility of balloon endoscope-assisted endoscopic retrograde cholangiopancreatography for the elderly

et al. 2020

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Background and study aims Endoscopic retrograde cholangiopancreatography (ERCP) for patients with surgically altered anatomy is challenging. Recently, balloon endoscopy has been shown to facilitate ERCP for this population with a high technical success rate, but adverse events (AEs) are not uncommon. Compared to non-elderly patients, elderly patients may be at higher risk of AEs due to underlying comorbidities. The current study aimed to evaluate the feasibility of balloon endoscope-assisted ERCP (BE-ERCP) for the elderly. Patients and methods We retrospectively identified patients who underwent BE-ERCP between January 2010 and September 2019. For patients who underwent multiple procedures during the study period, the first session was analyzed. Early AEs associated with BE-ERCP were compared between elderly (≥ 75 years) and non-elderly patients. Results A total of 1,363 BE-ERCP procedures were performed, and 568 patients (211 elderly and 357 non-elderly) were included for the analyses. Technical success rates were high in both the elderly and non-elderly groups (80 % vs. 80 %, respectively). The rates of early AEs were similar between the groups (12 % vs. 9.0 % in the elderly and non-elderly group, respectively; P = 0.31). The mltivariable-adjusted odds ratio for early AEs comparing elderly to non-elderly patients was 1.36 (95 % confidence interval, 0.74–2.51; P = 0.32). Specifically, we did not observe between-group differences in rates of gastrointestinal perforation (2.4 % vs. 2.8 % in elderly and non-elderly groups, respectively; P = 0.99) and aspiration pneumonia (1.9 % vs. 0.6 %, P = 0.20). Conclusions BE-ERCP is a feasible procedure for elderly individuals with surgically altered anatomy.

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Endoscopic papillary large balloon dilation and endoscopic papillary balloon dilation both without sphincterotomy for removal of large bile duct stones: A propensity‐matched analysis

Abstract: EPLBD without EST showed higher efficacy for removal of LBDS but was associated with worse long-term outcomes when compared to EPBD.

Cited by 27 publications

References 53 publications

Multiple recurrences after endoscopic removal of common bile duct stones: A retrospective analysis of 976 cases

Multiple recurrences after endoscopic removal of common bile duct stones: A retrospective analysis of 976 cases

Comparison of endoscopic papillary large balloon dilation with and without a prior endoscopic sphincterotomy for the treatment of patients with large and/or multiple common bile duct stones: a systematic review and meta-analysis

Feasibility of balloon endoscope-assisted endoscopic retrograde cholangiopancreatography for the elderly

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