Biliary sphincterotomy plus dilation with a large balloon for bile duct stones that are difficult to extract

Ersöz, Galip; Tekeşin, Oktay; Özütemiz, Ahmet Ömer; Günşar, Fulya

doi:10.1067/mge.2003.52

Cited by 338 publications

(359 citation statements)

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“…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.…”

Section: Discussionmentioning

confidence: 99%

“…For these reasons, sphincteroplasty (SP) with dilating balloons was introduced in 2003 as a routine method for expanding endoscopic sphincterotomies that are found to be insufficient. It was made of the same balloons designed for dilating stenotic zones in other sections of the gastrointestinal tract, with calibers ranging between 10 and 20 mm [6]. The present study was carried out to evaluate the efficacy and safety of the combination of ES with SP in our hands for the treatment of choledocholithiasis with extraction difficul-ties, and to determine whether the complications are greater than when only ES is performed (Figure 1).…”

Section: Introductionmentioning

confidence: 99%

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

Uribarrena-Amezaga¹,

Serna²,

Calvo-Morillas³

et al. 2013

OJGas

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Introduction: Endoscopic retrograde cholangiopancreatography (ERCP) with endoscopic sphincterotomy (ES) is the most widely used technique for treating choledocholithiasis.In some cases, due to anomalies of the papilla or the presence of large or multiple calculi, additional maneuvers are needed to remove the stones. The present study investigates the efficacy and safety of ES with sphincteroplasty (SP) in the management of choledocholithiasis with extraction difficulties. Patients and Methods: A prospective study was made of 153 patients with choledocholithiasis subjected to ERCP. Fifty-two patients underwent ES with SP, while 101 were subjected only to ES. The two groups were compared in terms of age, gender, percentage cannulation, presence of papilla alterations, large or multiple stones, success in stone removal and complications (acute pancreatitis, bleeding and perforation). In the ES with SP group, we moreover recorded the diameters of the balloons employed (10 -18 mm). Results: There were no significant differences between the groups in the stone extraction success rate (94.23% in the ES with SP group versus 97.03% in the ES group) or in the appearance of complications (3.8% in the ES with SP group versus 2.7% in the ES group). The presence of difficult papillae, and of multiple or large stones was significantly greater in the ES with SP group. The diameter of the balloon was not associated with the appearance of complications. Conclusion: Endoscopic sphincterotomy with sphincteroplasty is effective and safe in the treatment of choledocholithiasis with extraction difficulties.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Uribarrena-Amezaga¹,

Serna²,

Calvo-Morillas³

et al. 2013

OJGas

View full text Add to dashboard Cite

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“…Removal of large stones may be challenging when using EBD alone. Thus, Ersoz et al modified the technique of EBD by introducing EST prior to large balloon dilatation for the removal of large bile duct stones, which has now been described as endoscopic sphincterotomy with large balloon dilation (ELBD) [6].…”

Section: Introductionmentioning

confidence: 99%

Endoscopic Balloon Dilatation vs. Sphincterotomy in Cases of Calcular Obstructive Jaundice during Endoscopic Retrograde Cholangio Pancreatography

Rasheed¹

2017

J Gastrointest Dig Syst

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“…Accordingly, in 1977, the endoscopic removal of common bile duct (CBD) stones was restricted to patients post-cholecystectomy or in whom surgery was contraindicated [1].In 2004, Ersoz et al [2] introduced the technique of EST followed by large balloon dilation (ESLBD) designed to facilitate the removal of difficult bile duct stones after standard sphincterotomy had failed [2]. In 2006, a review in the Cochrane Database concluded that ELSBD was not only less efficient than standard EST for stone extraction but also increased the risk of pancreatitis.…”

mentioning

confidence: 99%

Sphincterotomy with Large Balloon to Extract Common Bile Duct Stones: Sometimes It Is Better to Get an “Incomplete”

Caillol

2015

Dig Dis Sci

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Pioneers in the practice of endoscopic retrograde cholangiopancreatography (ERCP) taught that complete endoscopic sphincterotomy (EST) was necessary in order to remove common bile duct stones despite its requirement for additional training and the risk of additional complications. Accordingly, in 1977, the endoscopic removal of common bile duct (CBD) stones was restricted to patients post-cholecystectomy or in whom surgery was contraindicated [1].In 2004, Ersoz et al. [2] introduced the technique of EST followed by large balloon dilation (ESLBD) designed to facilitate the removal of difficult bile duct stones after standard sphincterotomy had failed [2]. In 2006, a review in the Cochrane Database concluded that ELSBD was not only less efficient than standard EST for stone extraction but also increased the risk of pancreatitis. In most of the cases, however, balloon dilation was performed without previous sphincterotomy. The technique was restricted to patients with hemostasis disorders [3]. Nevertheless, with the publication of Ersoz et al., many teams began to realize that the rate of pancreatitis was in fact not so high as long as sphincterotomy was performed before ESLBD. In parallel, the risk of the use of cautery as part of the sphincterotomy procedure was associated with pancreatitis [4]. Thus, the idea to perform minor sphincterotomy in order to avoid hemorrhage and potentially cautery associated with pancreatitis was born.As a result, reviews of more recently published clinical studies have favored ESLBD, due to its relatively simplicity, lower cost, and faster completion than EST, without any increase in complications. Balloon dilation with partial sphincterotomy, no longer relegated as a salvage procedure, has now become first-line therapy [5][6][7]. There was, however, no uniformity regarding the optimal size of the sphincterotomy. Some groups safely performed complete sphincterotomy before balloon dilation [8], whereas others performed balloon dilation, both with very good results. Balloon dilation alone (i.e., without sphincterotomy) was associated with twice as many cases of pancreatitis [8,9]. Extraction of stones after balloon dilation did, however, prevent cholangitis and recurrence [9].In this issue of Digestive Diseases and Sciences, Mu et al. [10] have published an impressive prospective randomized trial of 300 patients with CBD stones. Patients were randomized to complete sphincterotomy (n = 148) or ESLBD (small sphincterotomy ? balloon dilation; [n = 152]). Success rate was similar in both groups (94 vs. 97 %). Post-ERCP pancreatitis was similar in both groups (6 vs. 7 %), but the ESLBD group had significantly less post-procedural bleeding (7 vs. 1 %; p \ 0.05). More interestingly, long-term recurrence was significantly less in those undergoing ESLB (1 vs. 7 %; p \ 0.05), independent of whether the patient ultimately underwent cholecystectomy. The authors postulate that the small sphincterotomy reduced injury to the CBD with less post-inflammatory stenosis and recurrence of symptomatic CBD...

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Biliary sphincterotomy plus dilation with a large balloon for bile duct stones that are difficult to extract

Cited by 338 publications

References 23 publications

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

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

Endoscopic Balloon Dilatation vs. Sphincterotomy in Cases of Calcular Obstructive Jaundice during Endoscopic Retrograde Cholangio Pancreatography

Sphincterotomy with Large Balloon to Extract Common Bile Duct Stones: Sometimes It Is Better to Get an “Incomplete”

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