Safety and efficacy of large balloon sphincteroplasty in a third care hospital

Abstract

Background and aims: large balloon sphincteroplasty (LBS) associated with sphincterotomy (ES) has gained acceptance as a useful tool in extracting difficult bile duct stones. Our purpose was to evaluate the efficacy and safety of LBS with balloons ≥ 10 mm in clinical practice setting.Patients and methods: unicentre prospective study in a tertiary care hospital. All patients who underwent LBS associated with ES between July 2007 and March 2011 were included prospectively in a database recording clinical aspects, procedure data, outcome and complications.Success is the main outcome defined as complete stone removal documented by absence of any filling defect during a final occlusion cholangiogram and absence of clinical or radiological findings after the ERCP consistent with remaining stones. Complications as pancreatitis, cholangitis, post-ERCP bleeding, perforation and others were also measured.Results: one hundred twenty procedures were made in 109 patients with balloons ranging from 10 to 20 mm. Success rate was 91% in the first attempt and 96.7% after two procedures. Mechanical lithotripsy was only needed in one case (0.8%). Complication rate was 4.2% due to five cases of post-ERCP bleeding in high risk patients.Conclusion: large balloon sphincteroplasty associated to sphincterotomy in clinical practice is a very effective and safe technique.

Management of CBD stones in patients having laparoscopic cholecystectomy in a private setting in Australia

“…With the increasingly widespread availability of advanced ERCP techniques, such as balloon sphincteroplasty and endoscopic choledochoscopy (e.g. Spyglass), even very large stones can be cleared endoscopically . This may make clearance of the bile duct at the time of surgery less imperative.…”

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

“…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].…”

“…Mechanical lithotripsy devices are not always easy to handle, and tend to significantly prolong the procedure. In addition, they are less effective in application to large or impacted stones, and have a relatively high complication rate [5,9,10]. More sophisti-cated intraductal lithotripsy techniques such as electrohydraulic or laser lithotripsy, etc., for the fragmentation of large stones, are expensive and available in very few centers [11][12][13][14].…”

“…In most cases, biliary duct stones can be removed by ERCP with ES, using a Dormia basket of Fogarty balloons [9]. However, in the presence of large or numerous stones, or when the papilla does not allow extensive ES, the usual technique is proved to be unable to extract the stones in up to 15% of the cases [3,4,10].…”

“…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.…”