Endoscopic Sphincterotomy Combined With Large Balloon Dilation Can Reduce the Procedure Time and Fluoroscopy Time for Removal of Large Bile Duct Stones

Abstract

ESLBD is an effective and safe treatment in patients with large bile duct stones. In addition, ESLBD appears to decrease procedure time and fluoroscopy time and reduce the need for mechanical lithotripsy as compared to EST alone.

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

“…Martín-Arranz maintains insufflation during one minute [9], while other authors limit this time to between 15 -30 seconds [13,17]. 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].…”

“…In addition, they are less effective in application to large or impacted stones, and have a relatively high complication rate [5,9,10]. More sophisti-cated intraductal lithotripsy techniques such as electrohydraulic or laser lithotripsy, etc., for the fragmentation of large stones, are expensive and available in very few centers [11][12][13][14]. The placement of plastic biliary stents may offer a temporary solution prior to surgical removal, or may represent a definitive treatment option in very elderly patients or individuals with a very high surgical risk [14,15].…”

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)

“…[7]. La SMSO permet également de réduire le temps de la procédure et de la fluoroscopie [8]. Ellee st plus sûre qu'une large SE (nécessaire pour extraire le gros calcul), qui peut conduire à la perforation.…”

“…Le temps de la procédure endoscopique dans notre étude était de 35 ± 5m in, il est comparable à celui rapporté dans la littérature. Ce temps reste réduit par rapport à celui d'une SE pour extraction des gros calculs comme l'a montré l'étude de Itoi et al: 32 min pour la SMSO vs 40 min pour la SE, p<0,05 [8]. La plupart des endoscopistes effectuent une SE de taillem oyenne avant la SMSO.C ette étape semble réduire le taux de complications, en particulier le risque de saignement [9].…”

Endoscopic Removal of Large Common Bile Duct Stones: Time to Arm the Laser?

“…LBD group [9]. A Japanese group reported in a retrospective analysis that adding LBD to EST decreased the procedure and fluoroscopy time as well as the need for ML compared with patients who underwent EST alone for extraction of stones [12 mm [10]. A US multi-center retrospective series of 103 patients with stones C12 mm demonstrated a 95 % success rate of ductal clearance with EST followed by LBD, although ML was required in 27 %.…”