Recurrent Common Bile Duct Stone and Endoscopic Treatment after Endoscopic Papillary Large Balloon Dilatation with Minor Endoscopic Sphincterotomy

Abstract

Background/Aims: Recent studies have reported the potentials of endoscopic papillary large balloon dilatation (EPLBD) with minor endoscopic sphincterotomy (EST) for the complete removal of common bile duct (CBD) stone in the high risk groups. However, there have been no reports about the recurrence of the CBD stone after EPLBD with minor EST. The aim of this study was to evlauate the recurrence of CBD stone after EPLBD with minor EST. Methods: A total of 1,036 patients who underwent endoscopic treatment due to CBD stones at Pusan University Hospital were enrolled. The patients were classified into two groups: those who underwent EPLBD with minor EST (group 1) and those who underwent EST treatment (group 2). We investigated clinical factors and recurrence rate between two groups. Results: The recurrence of CBD stone occurred in total of 74 patients (7%), and the recurrence rates of CBD stone were 21/321 (6.5%) in Group 1 and 53/715 (7.4%) in Group 2. There were no difference in the presence of diverticulum and the number and size of recurrent CBD stone between the two groups. In case of diverticulum existence, recurrence rates were 12/158 (7.6%) in Group 1 and 21/101 (20.8%) in Group 2. When compared to the case of no diverticulum existence (Group 1: 9/163 [5.5%], Group 2: 32/614 [5.2%]), the recurrence rate of CBD stone was significantly lower if treated after EPLBD with minor EST (p＜0.01). Conclusions: CBD stone that recurs after going through EPLBD with minor EST can be successfully removed with an endoscopic treatment. The recurrence of CBD stone was especially lower in cases with periampullary diverticulum and treated with EPLBD with minor EST. Our results will be helpful in endoscopic retreatment and preventing the recurrence of CBD stone. (Korean J Gastroenterol 2011;57:352-357)

Endoscopic sphincterotomy plus balloon dilation versus endoscopic sphincterotomy for choledocholithiasis: A meta‐analysis

“…Descriptive assessment and study characteristics. Out of 413 citations generated by the initial literature search, nine clinical trials with 1295 patients were finally enrolled in the meta-analysis according to the screening criteria, including six nonrandomized studies 11,[22][23][24][25][26] and three RCTs 9,27,28 (Fig. 1, Table 2).…”

“…The quality of nonrandomized studies were evaluated by NOS. Four out of six studies (66.7%) were ranked at level 2 (0–5) and two studies (33.3%) at level 1 (6–9) …”

Which Is the Better Treatment for the Removal of Large Biliary Stones? Endoscopic Papillary Large Balloon Dilation versus Endoscopic Sphincterotomy

“…However, there is no report about the physiologic and anatomical changes of the sphincter after EPLBD. Recent retrospective studies reported that the recurrence rate of choledocholithiasis was similar between EPLBD with limited EST and EST alone groups 15,16. However, these studies have some pitfalls which underestimated the preventive efficacy of recurrent stones by EPLBD since they did not take it account the fact that the patients who underwent EPLBD were more likely to have larger stones which could affect the biliary stone recurrence rate 17,18.…”

Size of recurrent symptomatic common bile duct stones and factors related to recurrence

“…However, for the recurrence of CBD stones, the role of EPLBD has not been established. Recently, it has been reported that more than 15 mm EPLBD prevented the short-term recurrence of CBD stones (7) while EPLBD (12 mm to 20 mm) reduced recurrence in patients with periampullary diverticula (8). Because large balloon dilation carries the risk of complications when the CBD is not adequately dilated or has a stricture, EPLBD should be performed cautiously, according to the CBD diameter.…”