Small sphincterotomy combined with papillary dilation with large balloon permits retrieval of large stones without mechanical lithotripsy

Minami, Atsushi; Hirose, Shinji; Nomoto, Tomohiro; Hayakawa, Shoichiro

doi:10.3748/wjg.v13.i15.2179

Cited by 145 publications

(124 citation statements)

References 19 publications

(11 reference statements)

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“…EPLBD combined with limited EST, which was first proposed to facilitate the removal of large or multiple bile duct stones, has been proven safe and effective in patients with large bile duct stones [27] . EPLBD combined with limited EST enlarged the biliary orifice enough to remove multiple or larger bile duct stones, resulting in an increased success rate of stone removal [28,29] and in decreased use of mechanical lithotripsy [9,12,13,[30][31][32][33] . In our study, compared with EST alone, the efficacy of stone removal was similar in EPBLD following limited EST.…”

Section: Resultsmentioning

confidence: 99%

“…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] .…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

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

Guo¹,

Meng²,

Duan³

et al. 2014

WJG

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AIM:To evaluate the efficacy and safety of endoscopic papillary large diameter balloon dilation (EPLBD) following limited endoscopic sphincterotomy (EST) and EST alone for removal of large common bile duct (CBD) stones. METHODS:We retrospectively compared EST + EPLBD (group A, n = 64) with EST alone (group B, n = 89) for the treatment of large or multiple bile duct stones. The success rate of stone clearance, procedure-related complications and incidents, frequency of mechanical lithotripsy use, and recurrent stones were recorded. RESULTS:There was no statistically significant difference between the two groups regarding periampullary diverticula (35.9% vs 34.8%, P > 0.05), pre-cut sphincterotomy (6.3% vs 6.7%, P > 0.05), size (12.1 ± 2.0 mm vs 12.9 ± 2.6 mm, P > 0.05) and number (2.2 ± 1.9 vs 2.4 ± 2.1, P > 0.05) of stones or the diameters of CBD (15.1 ± 3.3 mm vs 15.4 ± 3.6 mm, P > 0.05). There were no cases of perforation, acute cholangitis, or cholecystitis in the two groups. The rate of bleeding and the recurrence of CBD stones were significantly lower in group A than in group B [1/64 (1.6%) vs 5/89 (5.6%), P < 0.05; 1/64 (1.6%) vs 6/89 (6.7%), P < 0.05, respectively]. CONCLUSION:EST + EPLBD is an effective and safe endoscopic approach for removing large or multiple CBD stones. Key words: Choledocholithiasis; Endoscopic retrograde cholangiopancreatography; Endoscopic papillary balloon dilation; Endoscopic sphincterotomy Core tip: Endoscopic papillary large diameter balloon dilation (EPLBD) after limited endoscopic sphincterotomy (EST) is an effective and safe endoscopic approach to remove large or multiple common bile duct stones. Compared with EST alone, the rate of bleeding and recurrence of CBD stones were significantly lower in the EST + EPLBD group (1.6% vs 5.6%, P < 0.05; 1.6% vs 6.7%, P < 0.05, respectively). While the rates of overall stone removal and stone removal in the first session (96.9% vs 94.4%, P > 0.05; 90.6% vs 88.8%, P > 0.05, respectively) and the rates of post-endoscopic retrograde cholangiopancreatography pancreatitis and hyperamylasemia were not significantly different between the two groups (4.7% vs 4.5%, P > 0.05; 10.9% vs 10.1%, P > 0.05, respectively).Guo SB, Meng H, Duan ZJ, Li CY. Small sphincterotomy combined with endoscopic papillary large balloon dilation vs sphincterotomy alone for removal of common bile duct stones. World J Gastroenterol 2014; 20(47): 17962-17969 Available from: URL:

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Guo¹,

Meng²,

Duan³

et al. 2014

WJG

View full text Add to dashboard Cite

show abstract

“…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]. We indistinctly use Fogarty balloons or Dormia baskets, and sometimes combine both devices.…”

Section: Discussionmentioning

confidence: 99%

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

Uribarrena-Amezaga¹,

Serna²,

Calvo-Morillas³

et al. 2013

OJGas

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Introduction: Endoscopic retrograde cholangiopancreatography (ERCP) with endoscopic sphincterotomy (ES) is the most widely used technique for treating choledocholithiasis.In some cases, due to anomalies of the papilla or the presence of large or multiple calculi, additional maneuvers are needed to remove the stones. The present study investigates the efficacy and safety of ES with sphincteroplasty (SP) in the management of choledocholithiasis with extraction difficulties. Patients and Methods: A prospective study was made of 153 patients with choledocholithiasis subjected to ERCP. Fifty-two patients underwent ES with SP, while 101 were subjected only to ES. The two groups were compared in terms of age, gender, percentage cannulation, presence of papilla alterations, large or multiple stones, success in stone removal and complications (acute pancreatitis, bleeding and perforation). In the ES with SP group, we moreover recorded the diameters of the balloons employed (10 -18 mm). Results: There were no significant differences between the groups in the stone extraction success rate (94.23% in the ES with SP group versus 97.03% in the ES group) or in the appearance of complications (3.8% in the ES with SP group versus 2.7% in the ES group). The presence of difficult papillae, and of multiple or large stones was significantly greater in the ES with SP group. The diameter of the balloon was not associated with the appearance of complications. Conclusion: Endoscopic sphincterotomy with sphincteroplasty is effective and safe in the treatment of choledocholithiasis with extraction difficulties.

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“…PDCS using a conventional endoscope is usually more difficult to insert than an ultra-slim endoscope because of the diameter. However, endoscopic papillary large balloon dilation after EST may make insertion easier [5] . It also has the advantage of preventing increase in intra-biliary pressure during the procedure.…”

Section: Discussionmentioning

confidence: 99%

Endoscopic lithotripsy with peroral direct cholangioscopy using a conventional endoscope

Nakaji

Hirata²,

Shiratori³

et al. 2013

WJGE

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Recently, peroral direct cholangioscopy (PDCS) using an ultra-slim endoscope has come into the spotlight. However, the working channel is too small to use various devices for lithotripsy. We report a case of endoscopic lithotripsy with PDCS using a conventional endoscope as a cholangioscope. Computed tomography scan on an 80-year-old female who was admitted with acute cholangitis showed two large stones in the bile duct. Endoscopic retrograde cholangiopancreatography was attempted first. However, mechanical lithotripsy failed because the stone was too large for the basket catheter. Finally, electric hydraulic lithotripsy with PDCS using a conventional endoscope was performed allowed the stones to be cleared completely. In conclusion, PDCS using a conventional endoscope can be an alternative solution for endoscopic lithotripsy for patients with large stones in the dilated bile duct.

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Small sphincterotomy combined with papillary dilation with large balloon permits retrieval of large stones without mechanical lithotripsy

Cited by 145 publications

References 19 publications

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

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

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

Endoscopic lithotripsy with peroral direct cholangioscopy using a conventional endoscope

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