Large Balloon Dilation vs Mechanical Lithotripsy for the Management of Large Bile Duct Stones: A Prospective Randomized Study

Stefanidis, Gerasimos; Viazis, N.; Pleskow, Douglas K.; Manolakopoulos, Spilios; Theocharis, L; Christodoulou, C.; Kotsikoros, N.; Giannousis, J.; Sgouros, Spiros; Rodias, M.; Katsikani, A.; Chuttani, Ram; Rana, Surinder Singh

doi:10.1055/s-0039-1700304

Cited by 39 publications

(65 citation statements)

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“…In the systematic review by Kim et al, 32 the incidence of pancreatitis following EPLBD (balloon diameter: 12-20 mm) with EST was 2.4% (0%-13.2%), which included mild-to-moderate pancreatitis in 98.4% and severe pancreatitis in one patient who eventually died. Furthermore, in six RCTs 15,41,82,89,91,96 and five meta-analyses, 53,94,95,121,122 it was reported that there was no significant difference in the incidence of pancreatitis between EPLBD with EST and EST alone.…”

Section: Statement 4-4mentioning

confidence: 99%

“…With regard to stone diameter, EPLBD is indicated for stones ≥10 mm, 13 ≥12 mm, 11,12,15 and ≥15 mm. 14,16 Many reports have described the application of EPLBD for three or more stones.…”

Section: Indicationsmentioning

confidence: 99%

“…The primary procedural accidents and associated incidences include acute pancreatitis at 0%-13.2%, bleeding at 0%-10%, perforation at 0%-2.5%, and cholangitis at 0%-5.0%. [10][11][12][13][14][15]18,19,27,[29][30][31]41,44,52,[72][73][74] . In the systematic review of 32 articles by Kim et al, 32 they reported that EPLBD with EST had a significantly lower incidence of procedural accidents than EST alone (8.3% vs. 12.7%, OR: 1.60, P < 0.001).…”

Section: Procedure-related Adverse Eventsmentioning

confidence: 99%

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Japan Gastroenterological Endoscopy Society guidelines for endoscopic papillary large balloon dilation

Itoi

Ryozawa

Katanuma

et al. 2018

Digestive Endoscopy

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The Japan Gastroenterological Endoscopy Society has developed the 'EPLBD Clinical Practice Guidelines' as fundamental guidelines based on new scientific techniques. EPLBD is a treatment method that has recently become widely used for choledocolithiasis. The evidence level in this field is usually low, and in many instances, the recommendation grading has to be determined on the basis of expert consensus. At this point, the guidelines are divided into the following six sections according to the 'EST Clinical Practice Guidelines': (i) Indications, (ii) procedures, (iii) special cases, (iv) procedure-related adverse events, (v) treatment outcomes, and (vi) postoperative follow up observation.

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Section: Statement 4-4mentioning

confidence: 99%

Section: Indicationsmentioning

confidence: 99%

Section: Procedure-related Adverse Eventsmentioning

confidence: 99%

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Japan Gastroenterological Endoscopy Society guidelines for endoscopic papillary large balloon dilation

Itoi

Ryozawa

Katanuma

et al. 2018

Digestive Endoscopy

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“…Among the 12 reported series included, EST combined with EPLBD and EST alone were compared in three randomized controlled trials 12,16,18 and two retrospective analyses 15,19 . Only Stefanidis et al 18 identified an lower overall complication rate with combined EST and EPLBD compared with EST with ML (4% vs 20%, P < 0.05), and all failed to identify statistically significant differences in initial and final success rates between these two groups. Both the two retrospective analyses demonstrated a less frequent use of ML and higher rate of initial clearance by the combined therapy.…”

Section: Discussionmentioning

confidence: 99%

Endoscopic papillary large‐balloon dilation following limited sphincterotomy for the removal of refractory bile duct stones: Experience of 169 cases in a single Chinese center

Yang

Pan

et al. 2013

J of Digest Diseases

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“…[3][4][5][6] Endoscopic papillary large balloon dilation (EPLBD) has been introduced to clinical practice because of its effectiveness in removal of large bile duct stones during ERCP. [7][8][9][10][11] Although EPLBD is often carried out following endoscopic sphincterotomy (EST), [8][9][10][11] several researchers advocate that EPLBD alone may be similarly effective without a significant increase in post-ERCP pancreatitis, potentially contributing to a reduced rate of procedurerelated bleeding. [12][13][14][15] Safety of endoscopic papillary balloon dilation (EPBD) for patients with coagulopathy has been reported; 16,17 however, that of papillary dilation using a larger balloon catheter has not been well investigated.…”

Section: Introductionmentioning

confidence: 99%

Endoscopic papillary large balloon dilation without sphincterotomy for users of antithrombotic agents: A multicenter retrospective study

Hakuta

Kogure

Nakai

et al. 2019

Digestive Endoscopy

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Background and Aim With an aging population, an increasing number of individuals on antithrombotic agents are diagnosed with large bile duct stones. Studies have shown the effectiveness of endoscopic papillary large balloon dilation (EPLBD) for removal of large bile duct stones. EPLBD without endoscopic sphincterotomy (EST) may reduce the risk of procedure‐related bleeding, but the safety of this procedure for users of antithrombotic agents remains unclear. Methods In this multicenter retrospective study, we included patients who underwent EPLBD without EST for bile duct stones between March 2008 and December 2017. We compared adverse events and other clinical outcomes between users and non‐users of antithrombotic agents (antiplatelet agents and anticoagulants). Results We analyzed a total of 144 patients (47 users and 97 non‐users of antithrombotic agents). Among the users, the agents were continued in 13% and were replaced with heparin in 62% during the periprocedural period. We did not observe clinically significant bleeding and thrombotic events irrespective of the use of antithrombotic agents. Overall rate of early adverse events did not differ between users and non‐users (6.4% and 7.2%, P = 0.99). Procedural outcomes did not differ between the groups (necessity for lithotripsy, 28% vs. 29%; and complete stone removal in a single session, 72% vs. 71%, for users and non‐users, respectively). Conclusions Endoscopic papillary large balloon dilation without EST may be done without a substantial increase in procedure‐related bleeding for users of antithrombotic agents. A larger study is required to refine the management strategy for those agents during the periprocedural period.

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Large Balloon Dilation vs Mechanical Lithotripsy for the Management of Large Bile Duct Stones: A Prospective Randomized Study

Cited by 39 publications

References 0 publications

Japan Gastroenterological Endoscopy Society guidelines for endoscopic papillary large balloon dilation

Japan Gastroenterological Endoscopy Society guidelines for endoscopic papillary large balloon dilation

Endoscopic papillary large‐balloon dilation following limited sphincterotomy for the removal of refractory bile duct stones: Experience of 169 cases in a single Chinese center

Endoscopic papillary large balloon dilation without sphincterotomy for users of antithrombotic agents: A multicenter retrospective study

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