Long‐term Prognosis of Bile Duct Stones: Endoscopic Papillary Balloon Dilatation Versus Endoscopic Sphincterotomy

Kojima, Yuko; Nakagawa, Hiroshi; Miyata, Akihiro; Hirai, Takanori; Ohyama, Itaru; A, Okada; Hiramatsu, Takeshi; Ohhara, Yasuji; Kuwahara, Takamichi

doi:10.1111/j.1443-1661.2009.00913.x

Cited by 23 publications

(13 citation statements)

References 7 publications

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“…Bile duct stone recurrence rate after ES-LBD was 6.9%, which was similar to that of previous studies that evaluated ES-EPBD or EPBD alone 4,5,14. There was no significant difference in potential risk factors for bile duct stone recurrence between the ES alone and the ES-LBD group.…”

Section: Discussionsupporting

confidence: 86%

“…On the other hand, these factors may prompt the use of ES-LBD for stone removal. Gallbladder stone is a known risk factor for bile duct stone recurrence 14,15. Cholecystectomy is usually recommended to prevent bile duct stone recurrence.…”

Section: Discussionmentioning

confidence: 99%

“…A previous study showed that the risk factors for CBD stone recurrence after ES only include older age, dilation of the CBD (≥13 mm), previous open or laparoscopic cholecystectomy, presence of periampullary diverticulum, and more acute CBD angulation (≤145°) 17. Known risk factors for recurrent stones after ES and EPBD vary from study to study and include presence of a periampullary diverticulum, gallbladder stones left in situ , dilated CBD, previous cholecystectomy, no confirmation of a clean duct on intraductal ultrasonography, and mechanical lithotripsy 5,14,15,18. Risk factors for recurrent stones after ES-LBD are less well studied.…”

Section: Discussionmentioning

confidence: 99%

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Late Complications and Stone Recurrence Rates after Bile Duct Stone Removal by Endoscopic Sphincterotomy and Large Balloon Dilation are Similar to Those after Endoscopic Sphincterotomy Alone

et al. 2013

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Background/AimsBetween endoscopic sphincterotomy (ES) alone and combined endoscopic sphincterotomy and large balloon dilation (ES-LBD) groups, efficacy and long-term complications, difference in biliary stone recurrence rate, and risk factors of stone recurrence were compared.MethodsMedical records of 222 patients who underwent ERCP for biliary stone removal were retrospectively reviewed. Patients with dilated CBD ≥11 mm and follow-up longer than 6 months were included.ResultsThere were 101 patients in ES-LBD group and 121 patients in ES group. Mean follow-up duration was 25.0 (6-48) months and 13.0 (6-43) months, respectively (p=0.001). There was no difference in number of ERCP sessions, brown pigment stones, angle between mid and distal common bile duct (CBD angle) <135°, and lithotripsy rate. Complete retrieval success rate was excellent in both groups (100% vs. 99%). Early complication rate of ES-LBD and ES alone group was 4 and 4.1%, respectively (p=1.000). One patient in ES-LBD group died from delayed bleeding. Late complication rate was 5.9 and 3.3%, respectively (p=1.000). Stone recurrence rate was 6.9% and 5.8%, respectively (p=0.984). The only Independent risk factor of stone recurrence was presence of periampullary diverticulum.ConclusionsLate complication and stone recurrence rates were similar between ES-LBD and ES alone groups.

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Section: Discussionsupporting

confidence: 86%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Late Complications and Stone Recurrence Rates after Bile Duct Stone Removal by Endoscopic Sphincterotomy and Large Balloon Dilation are Similar to Those after Endoscopic Sphincterotomy Alone

et al. 2013

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“…First, EPBD results in less trauma to the ampullary sphincter. Second, EPBD might preserve the function of the biliary sphincter [2] , reducing late complications such as the recurrence of biliary stones [23,24] . Third, EPBD has the advantage of less bleeding and is safer for patients with bleeding tendency.…”

Section: Resultsmentioning

confidence: 99%

Small sphincterotomy combined with endoscopic papillary large balloon dilationvssphincterotomy alone for removal of common bile duct stones

Guo¹,

Meng²,

Duan³

et al. 2014

WJG

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AIM:To evaluate the efficacy and safety of endoscopic papillary large diameter balloon dilation (EPLBD) following limited endoscopic sphincterotomy (EST) and EST alone for removal of large common bile duct (CBD) stones. METHODS:We retrospectively compared EST + EPLBD (group A, n = 64) with EST alone (group B, n = 89) for the treatment of large or multiple bile duct stones. The success rate of stone clearance, procedure-related complications and incidents, frequency of mechanical lithotripsy use, and recurrent stones were recorded. RESULTS:There was no statistically significant difference between the two groups regarding periampullary diverticula (35.9% vs 34.8%, P > 0.05), pre-cut sphincterotomy (6.3% vs 6.7%, P > 0.05), size (12.1 ± 2.0 mm vs 12.9 ± 2.6 mm, P > 0.05) and number (2.2 ± 1.9 vs 2.4 ± 2.1, P > 0.05) of stones or the diameters of CBD (15.1 ± 3.3 mm vs 15.4 ± 3.6 mm, P > 0.05). There were no cases of perforation, acute cholangitis, or cholecystitis in the two groups. The rate of bleeding and the recurrence of CBD stones were significantly lower in group A than in group B [1/64 (1.6%) vs 5/89 (5.6%), P < 0.05; 1/64 (1.6%) vs 6/89 (6.7%), P < 0.05, respectively]. CONCLUSION:EST + EPLBD is an effective and safe endoscopic approach for removing large or multiple CBD stones. Key words: Choledocholithiasis; Endoscopic retrograde cholangiopancreatography; Endoscopic papillary balloon dilation; Endoscopic sphincterotomy Core tip: Endoscopic papillary large diameter balloon dilation (EPLBD) after limited endoscopic sphincterotomy (EST) is an effective and safe endoscopic approach to remove large or multiple common bile duct stones. Compared with EST alone, the rate of bleeding and recurrence of CBD stones were significantly lower in the EST + EPLBD group (1.6% vs 5.6%, P < 0.05; 1.6% vs 6.7%, P < 0.05, respectively). While the rates of overall stone removal and stone removal in the first session (96.9% vs 94.4%, P > 0.05; 90.6% vs 88.8%, P > 0.05, respectively) and the rates of post-endoscopic retrograde cholangiopancreatography pancreatitis and hyperamylasemia were not significantly different between the two groups (4.7% vs 4.5%, P > 0.05; 10.9% vs 10.1%, P > 0.05, respectively).Guo SB, Meng H, Duan ZJ, Li CY. Small sphincterotomy combined with endoscopic papillary large balloon dilation vs sphincterotomy alone for removal of common bile duct stones. World J Gastroenterol 2014; 20(47): 17962-17969 Available from: URL:

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“…It is presumed that EPBD could preserve the sphincter function and reduce the occurrence of duodenobiliary reflux and bacteria contamination, thus decreasing the biliary stone recurrence. 10,12 A retrospective study by Kojima et al 12 revealed that the recurrence rate of CBD stones was higher in 233 patients after EST than in 453 patients after EPBD (17.0% vs. 6.8%, p < 0.05), and the sphincter of Oddi function was protected in 70% patients after EPBD. A meta-analysis also showed that the stone recurrence rate was significantly reduced in EPBD as compared with that in EST.…”

Section: Recurrence Rate Of Biliary Stones After Epbd/eplbd or Estmentioning

confidence: 95%

Usefulness of endoscopic papillary balloon dilation for removal of common bile duct stones as compared to endoscopic sphincterotomy

Chen

2015

Journal of the Chinese Medical Association

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Long‐term Prognosis of Bile Duct Stones: Endoscopic Papillary Balloon Dilatation Versus Endoscopic Sphincterotomy

Abstract: Low-pressure EPBD in combination with isosorbide dinitrate enabled preservation of papillary functions by 70%, which would improve a long-term prognosis.

Cited by 23 publications

References 7 publications

Late Complications and Stone Recurrence Rates after Bile Duct Stone Removal by Endoscopic Sphincterotomy and Large Balloon Dilation are Similar to Those after Endoscopic Sphincterotomy Alone

Late Complications and Stone Recurrence Rates after Bile Duct Stone Removal by Endoscopic Sphincterotomy and Large Balloon Dilation are Similar to Those after Endoscopic Sphincterotomy Alone

Small sphincterotomy combined with endoscopic papillary large balloon dilationvssphincterotomy alone for removal of common bile duct stones

Usefulness of endoscopic papillary balloon dilation for removal of common bile duct stones as compared to endoscopic sphincterotomy

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