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Significance of Endoscopic Sphincterotomy Preceding Endoscopic Papillary Large Balloon Dilation in the Management of Bile Duct Stones

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Abstract

Background

Endoscopic papillary large balloon dilation (EPLBD) is safe and effective in management of common bile duct stones (CBDS). Endoscopic sphincterotomy (EST) prior to EPLBD has been performed as a standard procedure. However, the significance of EST prior to EPLBD has not been well studied yet.

Aims

To compare the clinical outcomes of EPLBD with and without EST to evaluate the significance of EST.

Methods

Between April 2010 and March 2015, a total of 82 patients with naïve papillae underwent EPLBD with or without EST for the management of CBDS. A retrospective analysis compared the efficacy and safety of EPLBD with and without EST.

Results

Basic patient characteristics were not significantly different between the groups that underwent EPLBD with EST (n = 27) and without EST (n = 55). Complete stone removal rates were similar between the groups (100 % in the EST group and 98 % in the non-EST group, p = 1.00). There was no significant difference in the median balloon size (13 mm in both groups, p = 0.445), rate of application of mechanical lithotripsy (26 vs. 35 % in the EST and non-EST groups, respectively, p = 0.463), or the median procedure time (38 vs. 34 min in the EST and non-EST groups, respectively, p = 0.682). The overall adverse event rates were not statistically different (4 vs. 7 % in the EST and non-EST groups, respectively, p = 1.00). Pancreatitis, cholangitis, and hemorrhage rates were also similar in both groups.

Conclusions

EST prior to EPLBD may be unnecessary since this study did not demonstrate its benefits.

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Authors and Affiliations

  1. First Department of Internal Medicine, Gifu University Hospital, 1-1 Yanagido, Gifu, 501-1194, Japan

    Mitsuru Okuno, Takuji Iwashita, Kensaku Yoshida, Akinori Maruta, Shinya Uemura & Masahito Shimizu

  2. Department of Gastroenterology, Gifu Municipal Hospital, Gifu, Japan

    Masanori Nakashima & Tsuyoshi Mukai

  3. Department of Gastroenterology, Gifu Prefectural General Medical Center, Gifu, Japan

    Nobuhiro Ando & Keisuke Iwata

  4. Department of Gastroenterology, Gihoku Kousei Hospital, Gifu, Japan

    Yohei Horibe & Seiji Adachi

  5. Department of Gastroenterology, Teikyo University Mizonokuchi Hospital, Kawasaki, Japan

    Masatoshi Mabuchi, Shinpei Doi & Ichiro Yasuda

Authors
  1. Mitsuru Okuno
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  2. Takuji Iwashita
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  3. Kensaku Yoshida
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  4. Akinori Maruta
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  5. Shinya Uemura
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  6. Masanori Nakashima
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  7. Tsuyoshi Mukai
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  8. Nobuhiro Ando
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  9. Keisuke Iwata
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  10. Yohei Horibe
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  11. Seiji Adachi
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  12. Masatoshi Mabuchi
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  13. Shinpei Doi
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  14. Ichiro Yasuda
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  15. Masahito Shimizu
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Corresponding author

Correspondence to Takuji Iwashita.

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Conflicts of interest

Drs. Mitsuru Okuno, Takuji Iwashita, Kensaku Yoshida, Akinori Maruta, Shinya Uemura, Masanori Nakashima, Tsuyoshi Mukai, Nobuhiro Ando, Keisuke Iwata, Yohei Horibe, Seiji Adachi, Masatoshi Mabuchi, Shinpei Doi, Ichiro Yasuda, and Masahito Shimizu have no conflicts of interest of financial ties to disclose.

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Okuno, M., Iwashita, T., Yoshida, K. et al. Significance of Endoscopic Sphincterotomy Preceding Endoscopic Papillary Large Balloon Dilation in the Management of Bile Duct Stones. Dig Dis Sci 61, 597–602 (2016). https://doi.org/10.1007/s10620-015-3891-6

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  • DOI: https://doi.org/10.1007/s10620-015-3891-6

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