Endoscopic sphincteroplasty: a novel and safe alternative to papillotomy in the management of bile duct stones.

Mathúna, Padraic Mac; White, Peggy; Clarke, Eileen; Lennon, J.; Crowe, J.

doi:10.1136/gut.35.1.127

Cited by 85 publications

(31 citation statements)

References 9 publications

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“…Ersoz et al [13] were the first investigators to use sequential EST and EPBD using large-diameter balloons for sphincteroplasty. All of the studies on EPBD alone had used balloons of 8 and 10 mm in diameter, which obviously limited the extraction of large stones [18][19][20][21]. Ersoz et al chose 58 patients who had failed EST and stone extraction, and dilated the sphincter with 10-20-mm balloons.…”

Section: Discussionmentioning

confidence: 98%

Sequential Endoscopic Papillary Balloon Dilatation Following Limited Sphincterotomy for Common Bile Duct Stones

et al. 2008

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Endoscopic papillary balloon dilatation (EPBD) has been recently used in conjunction with endoscopic sphincterotomy (EST) for the removal of common bile duct (CBD) stones. The present study was aimed at assessing the safety and outcome of sequential EPBD following EST for CBD stones. A total of 74 patients (43 females, mean age 41 years) with > or = 10-mm stone(s) in the CBD were selected for the procedure, which included limited EST followed by EPBD with balloon dilators of 10-18 mm in size. Eleven patients had undergone EST and unsuccessful stone removal earlier. Forty-nine patients had symptoms of CBD stones, while 25 were detected on imaging. Eleven patients had previous CBD stent in situ and four had T-tube in situ. The stone size was 10-12 mm in 34, 13-14 mm in 26, and > or = 15 mm in 14 patients. Thirty-one patients had a single stone, while 43 had > or = 2 stones. The successful removal of stones was achieved in 68 (91.9%) patients; 62 in the first attempt, five in the second, and one in the third. Six patients were deemed to be "failures." In two of them, the stones could be removed after mechanical lithotripsy. Complications were seen in 16 patients, with self-limiting pain in 13, self-limiting ooze in five, melaena in one, and mild pancreatitis in two. One patient had impaction of the dormia basket. We conclude that EPBD following EST is safe and effective in removing stones > or = 10 mm in size in over 90% of patients.

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Section: Discussionmentioning

confidence: 98%

Sequential Endoscopic Papillary Balloon Dilatation Following Limited Sphincterotomy for Common Bile Duct Stones

et al. 2008

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“…Endoscopic removal of small MBD stones through the intact papilla after or without pneumatic dilatation of the sphincter is being increasingly performed. 20,21 Whether there will be long-term consequences to the sphincter from this approach remains to be seen. Most complications related to LC, such as residual stones and biliary leaks, can be treated effectively by endoscopy.…”

Section: Discussionmentioning

confidence: 99%

Role of Endoscopic Retrograde Cholangiopancreatography Before and After Laparoscopic Cholecystectomy

et al. 1998

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Background: While the role of endoscopic retrograde cholangiopancreatography (ERCP) and. endoscopic sphincterotomy (EST) in the diagnosis and management of choledocholithiasis is well established, this study evaluates the usefulness of ERCP and EST in patients with symptomatic cholecystolithiasis and suspected choledocholithiasis before undergoing laparoscopic cholecystectomy (LC), and the role of ERCP-EST in the management of complications resulting from LC. Materials and Methods: This paper reviews retrospectively our experience from 1992 to 1995. A total of 1221 LCs and 717 ERCPs were performed, out of which 257 ERCPs were performed on 225 patients who underwent LC (230 ERCPs before and 27 after). The age range was 10-85 years (mean 43.5). The study group comprised 148 females (66%) and 77 males (34%). Results: The overall success rate for ERCP was 92% (96% for diagnostic and 88% for therapeutic). Choledocholithiasis was found at preoperative ERCP in 45% of cases. Prediction of choledocholithiasis was accurate in 46%, based on abnormal liver chemistry, and 70% when based on a combination of abnormal liver tests and dilated main bile duct (>7 mm) by ultrasound. In 40 cases of acute biliary pancreatitis, choledocholithiasis was found at ERCP in eight cases (20%). In the post-LC group, all eight cases with residual stones and seven of eight cases with bile leaks were successfully treated endoscopically. There were four cases with major duct injuries that required surgical management. The complications related to ERCP-EST included two cases of bleeding post-EST (one was controlled with injection therapy and the second one was managed surgically), and three cases of mild pancreatitis. Conclusion: ERCP and EST are effective and safe in the diagnosis and management of choledocholithiasis, and facilitate LC for symptomatic cholelithiasis. The procedures are also valuable in the diagnosis and management of most complications resulting from LC.

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“…Endoscopic sphincterotomy (EST) is accepted as the standard management for stone removal from the bile duct, but it is associated with serious complications such as hemorrhage, pancreatitis, perforation, and recurrent infection of the bile duct, which cause permanent functional loss of the sphincter of Oddi [1][2][3][4] . Endoscopic papillary balloon dilation (EBD) was introduced by Staritz et al [5] and has been accepted widely as an alternative to EST [6][7][8][9][10] . It has similar outcomes for common bile duct stone removal compared to EST, and has the advantages over EST of preserving papillary sphincter function and causing minimal complications such as hemorrhage and perforation [11][12][13][14][15][16][17][18][19] .…”

Section: Introductionmentioning

confidence: 99%

Small sphincterotomy combined with endoscopic papillary large balloon dilation versus sphincterotomy

Kim¹,

Cheon²,

Cho³

et al. 2009

WJG

101

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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:

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Endoscopic sphincteroplasty: a novel and safe alternative to papillotomy in the management of bile duct stones.

Cited by 85 publications

References 9 publications

Sequential Endoscopic Papillary Balloon Dilatation Following Limited Sphincterotomy for Common Bile Duct Stones

Sequential Endoscopic Papillary Balloon Dilatation Following Limited Sphincterotomy for Common Bile Duct Stones

Role of Endoscopic Retrograde Cholangiopancreatography Before and After Laparoscopic Cholecystectomy

Small sphincterotomy combined with endoscopic papillary large balloon dilation versus sphincterotomy

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