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

Abstract

AIM:To assess the efficacy and safety of endoscopic papillary large balloon dilation after biliary sphincterotomy for difficult bile duct stones retrieval. METHODS:Retrospective review of consecutive patients submitted to the technique during 18 mo. The main outcomes considered were: efficacy of the procedure (complete stone clearance; number of sessions; need of lithotripsy) and complications. RESULTS:A total of 30 patients with a mean age of 68 ± 10 years, 23 female (77%) and 7 male (23%) were enrolled. In 10 patients, a single stone was found in the common bile duct (33%) and in 20 patients multiple stones (67%) were found. The median diameter of the stones was 17 mm (12-30 mm). Dilations were performed with progressive diameter Through-TheScope balloons (up to 12, 15) or 18 mm. Complete retrieval of stones was achieved in a single session in 25 patients (84%) and in two sessions in 4 patients (13%). Failure occurred in 1 case (6%). Mechanical lithotripsy was performed in 6 cases (20%). No severe complications occurred. One patient (3%) had mild-grade post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis. CONCLUSION:Endoscopic balloon dilatation with a large balloon after endoscopic sphincterotomy is a safe and effective technique that could be considered an alternative choice in therapeutic ERCP.

Immediate balloon deflation method in endoscopic papillary large balloon dilation for extraction of difficult bile duct stones

“…In our study, overall success rate for complete stone removal using the immediate balloon deflation method was very high (78/80, 97.5%), which is comparable to other EPLBD studies [2][3][4]6,7], and the success rate at first ERCP for complete stone removal was acceptable (69/80, 86.3%). In addition, in our study, compared to other studies, the use of mechanical lithotripsy, which is a very important factor for assessing efficacy, was very low (actually, none).…”

“…According to the reports [1][2][3][4][5][6][7][8][9], the success rate of CBD stone clearance was similar in EPLBD compared to EST alone. Mechanical use was less frequent in EPLBD, although mechanical usage in large stones was similar.…”

“…Since then, several studies of EPLBD [2][3][4][5][6][7][8][9] for treatment of difficult bile duct stones have reported favorable outcomes and acceptable complication rates. In addition, a recent meta-analysis [10] reported that EPLBD should be considered as an alternative for patients in whom EST could not be routinely performed; it was also recommended for removal of large or difficult common bile duct stones in patients with an underlying coagulopathy or need for anticoagulation following endoscopic retrograde cholangiopancreatography (ERCP) because cases of hemorrhage in EPLBD are fewer than in EST.…”

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).…”

Small sphincterotomy combined with endoscopic papillary large balloon dilationvssphincterotomy alone for removal of common bile duct stones

“…To overcome these disadvantages, endoscopic papillary large diameter balloon dilation (EPLBD) after limited EST was introduced for the removal of large (≥ 10 mm) or multiple bile duct stones [9][10][11][12][13][14][15][16][17][18][19][20][21][22] . This method combines the advantages of EST and EPBD by increasing the efficacy of stone extraction while minimizing complications of EST and EPBD when used alone [9,21] .…”