Endoscopic papillary balloon dilation after sphincterotomy for difficult choledocholithiasis: A case-controlled study

Abstract

EST+EPLBD is a safe and effective technique for treatment of difficult BDS, leading to high rates of complete stone clearance and reducing the need for lithotripsy and biliary stenting.

Do not rush for surgery; stent placement may be an effective step for definitive treatment of initially unextractable common bile duct stones with ERCP

“…In this study, 28 % of CBD stones could not be extracted with basket or balloon interventions. Although this is a relatively high percentage, when the multiplicity and mean diameter of the stones (15 mm) in this cohort are considered, it is comparable with the literature declaring retrieval rate of 69.8 % after sphincterotomy alone, and in the same study, it was reported that endoscopic papillary balloon dilatation after sphincterotomy increased clearance rates of the stones in the same session [7]. However, in another study, it has been advised to delay endoscopic papillary balloon dilatation for a second session, otherwise complications such as perforation, bleeding or pancreatitis can be observed [8].…”

“…57.5 % had a single bile duct stone, and the median diameter was 15 mm (7-30). The most commonly placed stents was 7 [5][6][7][8][9][10][11][12] cm in length and 10 [7][8][9][10] Fr in diameter. The median interval between the procedures was 2 (1-28) months (Table 1), and 90 % (n = 39) of the procedures were performed within 3 months.…”

International consensus guidelines for endoscopic papillary large-balloon dilation

“…The initial success rate, which was defined as the rate of successful stone removal during the first ERCP session, of EPLBD with EST in the systematic review 18 was comparable to that of EST alone (84.0% vs 80.8%, P Z .131) in a meta-analysis by Weinberg et al 11 The initial www.giejournal.org Volume -, No. -: 2015 GASTROINTESTINAL ENDOSCOPY 5 success rate in EPLBD with EST was similar to that of EST alone in 1 retrospective cohort study, 20 in 4 of the 6 randomized, controlled trials [27][28][29][30] ; and in all 5 meta-analyses 16,[31][32][33]36 ; whereas it was significantly higher in EPLBD with EST than that in EST alone in another 2 retrospective cohort studies by Kim et al 25 and Rosa et al 26 and the remaining 2 randomized, controlled trials by Li at al 34 and Jun et al 35 The overall success rate of EPLBD with EST in the previously mentioned systematic review 18 was comparable to that of EST alone (96.5% vs 95.3%, P Z .141) in a previous meta-analysis. 11 The overall success rate of EPLBD with EST was similar to that of EST alone in 2 of 3 retrospective cohort studies 20,25 ; in all 6 randomized, controlled trials [27][28][29][30]34,35 and in all 5 meta-analyses, 16,[31][32][33]36 whereas it was significantly higher in EPLBD with EST than in EST alone in the remaining retrospective cohort study by Rosa et al 26 Based on these results, the initial and overall success rates of EPLBD with EST are comparable to, or somewhat better than, those of EST alone.…”

“…performed. All recent studies that were conducted to compare the clinical outcomes of EPLBD with limited EST with EST alone as an initial stone extraction technique in patients with large bile duct stones, constituting 2 retrospective cohort studies 25,26 and 5 randomized, controlled trials, [27][28][29][30]35 showed similar or even better initial and overall success rates of stone clearance and rates of adverse events. In addition, 2 retrospective case series reported that initial EPLBD without a preceding EST could be safely and effectively used as an alternative stone extraction technique to EST alone in patients with large bile duct stones.…”

La SMSO (Sphinctérotomie avec macrodilatation du sphincter d’Oddi) dans le traitement des gros calculs de la voie biliaire principale : Expérience de l’Hôpital Militaire de Rabat (Maroc)

“…Dans notre étude, la clairance de la VBP était de 91,6%et nos résultats étaient comparables à ceux rapportésd ans la littérature. Deux études rétrospectives ont comparé les taux de succès de la SE et de la SMSO.E lles ont montré un taux d'extraction de calcul significativement plus élevésa près( SMSO) qu'aprèsS E( 84,2 %v s4 4,2 %, p<0,001 [16] et 87,5 %v s7 4,0 %, p=0,036 [17]). Dansl ap lupart des études, le recours à une LM aprèsS MSO est réduit par rapport à la SE [18].…”