Comparison of the usefulness of endoscopic papillary large-balloon dilation with endoscopic sphincterotomy for large and multiple common bile duct stones

Abstract

Background: Endoscopic sphincterotomy (EST) is currently recognized as the primary endoscopic treatment for common bile duct stones. However, it is difficult to remove multiple (≥3) or large (≥15mm) common bile duct stones with EST alone. Recently, EST plus endoscopic papillary large-balloon dilation (EPLBD) was reported to be an effective treatment for such bile duct stones. We compared the results of EST and EST+EPLBD for multiple (≥3) or large (≥15mm) stones that were difficult to treat using EST alone. We also compared the complication rates between the techniques. Methods: Seventy patients with large (largest diameter, ≥15mm) or≥3 common bile duct stones treated in our department between April 2010 and March 2013 underwent EST+EPLBD (n=34) or EST alone (n=36). We compared final successful stone removal rates, rates of successful stone removal in the first session, procedure times, status of concurrent mechanical lithotripsy (ML), and complications between the EST+EPLBD and EST groups. Results: The rates of final successful stone removal were similar between the two groups (EST+EPLBD: 100% vs. EST: 89%; p=0.115). The rate of successful stone removal in the first session was significantly higher in the EST+EPLBD group (EST+EPLBD: 88% vs. EST: 56%; p=0.03). Moreover, the procedure time was significantly shorter (EST+EPLBD: 42min vs. EST: 67min; p=0.011) and the rate of ML use was significantly lower in the EST+EPLBD group (EST+EPLBD: 50% vs. EST: 94%; p<0.001). Complications like pancreatitis and bleeding occurred in three patients in the EST+EPLBD group and in 10 patients in the EST group, but the differences were not statistically significant (EST+EPLBD: 9% vs. EST: 25%; p=0.112). Conclusions: Our results suggest that EST+EPLBD is an effective therapy for patients with difficult-to-treat multiple or large common bile duct stones, because it requires fewer sessions and shorter operative times than EST alone.