Small sphincterotomy combined with endoscopic papillary large balloon dilation versus sphincterotomy

Abstract

AIM:To compare small sphincterotomy combined with endoscopic papillary large balloon dilation (SES + ELBD) and endoscopic sphincterotomy (EST) for large bile duct stones. METHODS:We compared prospectively SES + ELBD (group A, n = 27) with conventional EST (group B, n = 28) for the treatment of large bile duct stones (≥ 15 mm). When the stone could not be removed with a normal basket, mechanical lithotripsy was performed. We compared the rates of complete stone removal with one session and application of mechanical lithotripsy. CONCLUSION: SES + ELBD did not show significant benefits compared to conventional EST, especially for the removal of large (≥ 15 mm) bile duct stones. RESULTS:

Endoscopic papillary large balloon dilation after limited sphincterotomy for difficult biliary stones

“…In conclusion, as reported by other authors [15][16][17][18][19] , our study showed that endoscopic papillary large balloon dilation appears to be a safe and effective technique for the removal of large bile duct stones and should be considered in the management of difficult bile duct stones.…”

“…Regarding the risk of haemorrhage, this sequential technique has been shown to be as safe as conventional EBD. As in other series [13,[15][16][17][18][19] , in ours, we did not have any cases of im- portant haemorrhage. Another issue to consider during EBD with a large balloon is the risk of perforation of the duodenum.…”

“…Additionally, the EST performed previously has the capacity to orientate the correct direction of the dilation and control the impact of its radial force. Hence, the theoretical risk of perforation is very low [13][14][15][16][17][18] . Again, we had no cases of this complication.…”

Sphincterotomy plus large balloon dilation versus sphincterotomy alone for the extraction of complex lithiasis: A prospective analysis

“…Since then, many studies have been published showing a success rate of 83 to 100% using 12 to 20 mm diameter to extract stones measuring 13 to 16 mm (11)(12)(13)(14)(15). In all studies except one (16), the need for ML was less than 10%.…”

Manejo del cálculo difícil en la vía biliar: Serie de casos

“…Se logró extraer los cálculos en 88% de los pacientes, LM fue requerida en 7% y complicaciones como colangitis leve, pancreatitis leve y sangrado sin necesidad de cirugía ocurrieron en 16% de los casos. Estudios posteriores donde combinan la técnica de dilatación endoscópica papilar con balón grande y la esfinterotomía endoscópica estándar han reportado una tasa de éxito entre 94% y 100%, complicaciones de 0% a 17%, con necesidad del uso de LM en 0% a 33% de los casos, por lo que esta técnica puede reducir la necesidad de LM, lo que minimiza los eventos adversos asociados a la litotripsia (39)(40)(41)(42)(43)(44)(45)(46)(47)(48)(49)(50)(51).…”