Abstract
Background
Endoscopic papillary large balloon dilation (EPLBD) after an endoscopic sphincterotomy (EST) is an option for endoscopic removal of large common bile duct (CBD) stones. However, risks or fear of severe adverse events remain.
Aims
Our aim was to compare the safety and efficacy of delayed EPLBD after EST with concurrent EST and EPLBD in patients with acute cholangitis by large CBD stones.
Patients and Methods
A total of sixty-eight patients with acute cholangitis from large CBD stones were enrolled in this prospective observational study. Thirty-five patients underwent concurrent EST and EPLBD at the same session (group A). Thirty-three patients underwent only EST at the first session, and EPLBD with stone removal was performed during a second session (group B). The complete stone removal rate and adverse events rate were analyzed.
Results
Both groups resulted in similar outcomes in terms of overall successful stone removal (100 % in both groups) and the use of additional lithotripsy (22.9 % in group A and 24.2 % in group B). Six patients (17.1 %) in group A had procedural-related adverse events including one patient with death by perforation, one with significant bleeding, and four with pancreatitis, including one moderate grade. However, there was no procedure-related complication in group B (p < 0.05).
Conclusions
Delayed EPLBD after EST may reduce complications associated with EPLBD and extraction of large bile duct stones in patients with acute cholangitis.
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Abbreviations
- EPLBD:
-
Endoscopic papillary large balloon dilation
- EST:
-
Endoscopic sphincterotomy
- CBD:
-
Common bile duct
- ML:
-
Mechanical lithotripsy
- ERCP:
-
Endoscopic retrograde cholangiopancreatography
References
Garg PK, Tandon RK, Ahuja V, Makharia GK, et al. Predictors of unsuccessful mechanical lithotripsy and endoscopic clearance of large bile duct stones. Gastrointest Endosc. 2004;59:601–605.
Williams EJ, Green J, Beckingham I, Parks R, et al. Guidelines on the management of common bile duct stones (CBDS). Gut. 2008;57:1004–1021.
Binmoeller KF, Bruckner M, Thonke F, Soehendra N. Treatment of difficult bile duct stones using mechanical, electrohydraulic and extracorporeal shock wave lithotripsy. Endoscopy. 1993;25:201–206.
Moon JH, Ko BM, Choi HJ, Koo HC, et al. Direct peroral cholangioscopy using an ultra-slim upper endoscope for the treatment of retained bile duct stones. Am J Gastroenterol. 2009;104:2729–2733.
Ersoz G, Tekesin O, Ozutemiz AO, Gunsar F. Biliary sphincterotomy plus dilation with a large balloon for bile duct stones that are difficult to extract. Gastrointest Endosc. 2003;57:156–159.
Heo JH, Kang DH, Jung HJ, Kwon DS, et al. Endoscopic sphincterotomy plus large-balloon dilation versus endoscopic sphincterotomy for removal of bile-duct stones. Gastrointest Endosc. 2007;66:720–726.
Kim TH, Oh HJ, Lee JY, Sohn YW. Can a small endoscopic sphincterotomy plus a large-balloon dilation reduce the use of mechanical lithotripsy in patients with large bile duct stones? Surg Endosc. 2011;25:3330–3337.
Itoi T, Itokawa F, Sofuni A, Kurihara T, et al. Endoscopic sphincterotomy combined with large balloon dilation can reduce the procedure time and fluoroscopy time for removal of large bile duct stones. Am J Gastroenterol. 2009;104:560–565.
Lee TH, Park SH, Lee CK, Chung IK, et al. Life-threatening hemorrhage following large-balloon endoscopic papillary dilation successfully treated with angiographic embolization. Endoscopy. 2009;41(Suppl 2):E241–E242.
Park SJ, Kim JH, Hwang JC, Kim HG, et al. Factors predictive of adverse events following endoscopic papillary large balloon dilation: results from a multicenter series. Dig Dis Sci. 2013;58:1100–1109.
Cotton PB, Lehman G, Vennes J, Geenen JE, et al. Endoscopic sphincterotomy complications and their management: an attempt at consensus. Gastrointest Endosc. 1991;37:383–393.
Meine GC, Baron TH. Endoscopic papillary large-balloon dilation combined with endoscopic biliary sphincterotomy for the removal of bile duct stones (with video). Gastrointest Endosc. 2011;74:1119–1126.
Feng Y, Zhu H, Chen X, Xu S, et al. Comparison of endoscopic papillary large balloon dilation and endoscopic sphincterotomy for retrieval of choledocholithiasis: a meta-analysis of randomized controlled trials. J Gastroenterol. 2012;47:655–663.
Teoh AY, Cheung FK, Hu B, Pan YM, et al. Randomized trial of endoscopic sphincterotomy with balloon dilation versus endoscopic sphincterotomy alone for removal of bile duct stones. Gastroenterology. 2013;144:341–345.
Liao WC, Lee CT, Chang CY, Leung JW, et al. Randomized trial of 1-minute versus 5-minute endoscopic balloon dilation for extraction of bile duct stones. Gastrointest Endosc. 2010;72:1154–1162.
Misra SP, Dwivedi M. Large-diameter balloon dilation after endoscopic sphincterotomy for removal of difficult bile duct stones. Endoscopy. 2008;40:209–213.
Attasaranya S, Cheon YK, Vittal H, Howell DA, et al. Large-diameter biliary orifice balloon dilation to aid in endoscopic bile duct stone removal: a multicenter series. Gastrointest Endosc. 2008;67:1046–1052.
Acknowledgments
This study was supported in part by the SoonChunHyang University Research Fund. All authors disclosed no financial relationships relevant to this publication.
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Lee, J.C., Moon, J.H., Choi, H.J. et al. Delayed Endoscopic Papillary Large Balloon Dilation After Sphincterotomy for Removing Large Bile Duct Stones in Patients with Acute Cholangitis. Dig Dis Sci 59, 1302–1306 (2014). https://doi.org/10.1007/s10620-013-3003-4
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DOI: https://doi.org/10.1007/s10620-013-3003-4