Comparison of endoscopic papillary balloon dilatation and endoscopic sphincterotomy for bile duct stones

Sakai, Yuji; Tsuyuguchi, Toshio; Sugiyama, Harutoshi; Hayashi, Masahiro; Senoo, Junichi; Kusakabe, Yuko; Yasui, Shin; Mikata, Rintaro; Yokosuka, Osamu

doi:10.4253/wjge.v8.i10.395

Cited by 3 publications

(9 citation statements)

References 49 publications

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“…According to most of the meta-analyses, the success rates of EST and EPBD for common bile duct stones were 94.3% and 96.5%, respectively 8 . The success rates of combining limited endoscopic sphincterotomy and balloon dilation in our study were 99.4% (3 min group) and 98.8% (1 min group), respectively, which were higher than those reported before, indicating that limited EST combined with balloon dilatation was effective for CBD stone removal.…”

Section: Discussionmentioning

confidence: 99%

“…Studies had found a relatively high incidence of pancreatitis after EPBD, especially when small (diameter ≤ 10 mm) balloon dilation was performed for small CBD stones (diameter ≤ 10 mm) 8 – 12 . Interestingly, it has been reported that the incidence of post-EPBD pancreatitis might be related to the duration of balloon dilation 13 – 16 .…”

Section: Introductionmentioning

confidence: 99%

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Optimal dilation duration of 10 mm diameter balloons after limited endoscopic sphincterotomy for common bile duct stones: a randomized controlled trial

Li,

Miao,

Wang

et al. 2024

Sci Rep

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Limited endoscopic sphincterotomy (EST) combined with endoscopic papillary balloon dilation (EPBD) is widely used. However, the optimal duration of small balloon dilation in choledocholithiasis remains controversial. We aimed to determine the optimal duration for 10 mm diameter balloon dilation after limited EST in choledocholithiasis. In this randomized controlled clinical trial, 320 patients were randomly assigned to receive small balloon dilation (10 mm in diameter) for 1 min (n = 160) or 3 min (n = 160) after deep bile duct cannulation. No significant difference in success rate of stone extraction between the two groups was observed. The incidence of post-ERCP pancreatitis (PEP) was higher in the 1 min group (10.6%) than in the 3 min group (4.4%) (P = 0.034). The logistic regression analysis showed that guidewire into the pancreatic duct, cannulation time > 5 min and 1 min balloon dilation were independent risk factors for PEP. There were no significant differences in other post-ERCP adverse events such as acute cholangitis, bleeding, perforation, etc. between the two groups. In conclusion, 3 min in duration was determined to be the optimal dilation condition for the removal of common bile duct stones.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Optimal dilation duration of 10 mm diameter balloons after limited endoscopic sphincterotomy for common bile duct stones: a randomized controlled trial

Li,

Miao,

Wang

et al. 2024

Sci Rep

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“…Several studies have attributed the lower incidence of long-term stone recurrence and cholangitis in the EPBD group compared with that in the EST group to papillary function preservation [23][24][25]. In contrast, the risk of PEP has been reported to be higher than that of EST [23][24][25]35].…”

Section: Discussionmentioning

confidence: 99%

“…As EST involves an incision of the main papilla, there is a risk of perforation and bleeding. Moreover, sphincter of Oddi function disruption could cause bacterial invasion and growth in the bile ducts and reflux of digestive juices [20][21][22], which are believed to be factors in bile duct stone recurrence [23][24][25].…”

Section: Introductionmentioning

confidence: 99%

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Case Series of Endoscopic Papillary Balloon Dilation for Children with Common Bile Duct Stones and a Review of the Literature

Kouchi,

Takenouchi,

Matsuoka

et al. 2024

JCM

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Background: Endoscopic sphincterotomy (EST) has been employed for the endoscopic treatment of common bile duct stones (CBDSs) and has been reported to have a high success rate for stone removal. However, EST is associated with a risk of bleeding, perforation, and sphincter of Oddi function disruption. To avoid these risks, endoscopic papillary balloon dilation (EPBD) is an option for CBDS. Sphincter of Oddi function preservation decreases long-term biliary infection and gallstone recurrence. EPBD may have advantages in children who require a long follow up. However, there have been few reports on pediatric cases, particularly in infants. Methods: From September 2017 to December 2023, we performed EPBD for four pediatric CBDSs. The patients were aged from 5 months to 8 years, including two infants aged 5 and 6 months. Furthermore, we reviewed the stone removal rate and complications of 545 ESTs performed at high-volume centers and 13 EPBD-reported cases in children with CBDSs. Results: CBDSs of all patients who underwent EPBD in our institution were successfully removed. No bleeding or perforation was noted; pancreatitis was observed in three patients. In an analysis of 545 ESTs in children, the stone removal rate was high, ranging from 83% to 100% (mean 96%). The incidence of pancreatitis was 0–9.6% (mean 4.4%), and the grade of pancreatitis was almost mild. The bleeding frequency was 1.3–5.4% (mean 2.7%). With regards to the grade of bleeding, seven cases were mild (64%) and four were moderate (36%). Compared with adults who underwent EST, the frequencies of pancreatitis and bleeding were almost equal in children; however, in children, once bleeding occurs, it has a higher risk of leading to blood transfusion. Stone removal via EPBD in children has a 100% success rate. Pancreatitis was responsible for all complications were related; its frequency was 46% (6/13 patients, including five mild cases and one moderate case), which is higher than that of EST and adult cases who underwent EPBD. In most children with pancreatitis, pancreatic enzyme levels returned to normal within 2–3 days following EPBD, and no severe cases caused by EPBD were reported. Conclusions: CBDS removal via EPBD in children has a high success rate with very low risk of bleeding and perforation. Although pancreatitis frequently occurs, most cases are mild. Sphincter of Oddi function preservation via EPBD is expected to prevent long-term stone recurrence and biliary tract infection, and EPBD is considered to be an effective method for CBDS removal in children.

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Endoscopic Papillary Balloon Dilation for Children with Common Bile Duct Stones, Especially for Infants: A Literature Review

Kouchi,

Takenouchi,

Matsuoka

et al. 2024

Preprint

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Background: Endoscopic sphincterotomy (EST) has been employed for the endoscopic treatment of common bile duct stones (CBDSs), and a high success rate of stone removal has been reported. However, EST is associated with the risk of bleeding, perforation, and sphincter of Oddi function disruption. To avoid these risks, endoscopic papillary balloon dilation (EPBD) is an option for CBDS. Sphincter of Oddi function preservation decreases long-term biliary infection and gallstone recurrence. EPBD may have advantages in children who require a long follow-up. However, there have been few reports on pediatric cases, particularly in infants. Methods: From September 2017 to December 2023, we performed EPBD for four pediatric CBDSs. The patients were aged from 5 months to 8 years; including two infants aged 5 and 6 months. Furthermore, we reviewed the stone removal rate and complications of 545 ESTs performed at high-volume centers and 13 EPBD-reported cases in children with CBDSs. Results: CBDSs of all patients who underwent EPBD in our institution were successfully removed. No bleeding or perforation was noted, and pancreatitis was observed in three patients. In an analysis of 545 ESTs in children, the stone removal rate was high, ranging from 83% to 100% (mean, 96%). The incidence of pancreatitis was 0%–9.6% (mean, 4.4%), and the grade of pancreatitis was almost mild. The bleeding frequency was 1.3%–5.4% (mean, 2.7%). According to the grade of bleeding, seven and four cases were mild (64%) and moderate (36%), respectively, Compared with adult cases who underwent EST, the frequency of pancreatitis and bleeding was almost similar in children.; however once bleeding occur, it has a higher risk of leading to blood transfusion in children. Stone removal by EPBD in children was 100% successful. All complications were pancreatitis, and its frequency was 46% (6/13 patients, including five mild cases and one moderate case), which is higher than that of EST and adult cases who underwent EPBD. In most children with pancreatitis, pancreatic enzyme levels returned to normal within 2–3 days following EPBD, and no severe cases caused by EPBD were reported. Conclusions: CBDS removal by EPBD in children has a high success rate with very low risk of bleeding and perforation. Although pancreatitis frequently occurs, most cases are mild. Sphincter of Oddi function preservation by EPBD is expected to prevent long-term stone recurrence and biliary tract infection, and EPBD is considered an effective method for CBDS removal in children.

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Comparison of endoscopic papillary balloon dilatation and endoscopic sphincterotomy for bile duct stones

Cited by 3 publications

References 49 publications

Optimal dilation duration of 10 mm diameter balloons after limited endoscopic sphincterotomy for common bile duct stones: a randomized controlled trial

Optimal dilation duration of 10 mm diameter balloons after limited endoscopic sphincterotomy for common bile duct stones: a randomized controlled trial

Case Series of Endoscopic Papillary Balloon Dilation for Children with Common Bile Duct Stones and a Review of the Literature

Endoscopic Papillary Balloon Dilation for Children with Common Bile Duct Stones, Especially for Infants: A Literature Review

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