Combined endoscopic sphincterotomy and large balloon sphincteroplasty for bile duct stones.
- Author:
Min Kyung KIM
1
;
Myung Hwan KIM
;
Tae Yoon LEE
;
Hyoung Chul OH
;
Seung Hyun KWON
;
Jeung Hye HAN
;
Hyung Oh CHOI
;
Soo Jung PARK
;
Tae Hyup KIM
;
Sang Soo LEE
;
Dong Wan SEO
;
Sung Koo LEE
Author Information
1. Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea. mhkim@amc.seoul.kr
- Publication Type:Original Article
- Keywords:
Endoscopic sphincterotomy;
Endoscopic papillary large balloon dilation;
Common bile duct stone
- MeSH:
Anti-Bacterial Agents;
Bile Ducts*;
Bile*;
Common Bile Duct;
Diverticulum;
Hemorrhage;
Humans;
Incidence;
Lithotripsy;
Mortality;
Pancreatitis;
Retrospective Studies;
Sphincterotomy, Endoscopic*
- From:Korean Journal of Medicine
2007;73(5):474-480
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
BACKGROUND: The combined use of small endoscopic sphincterotomy (EST) followed by endoscopic papillary large balloon dilation (EPLBD) might be associated with a lower incidence of procedure-related complications such as pancreatitis, bleeding or perforation, compared to the use of EPLBD or a large EST alone. The aim of this retrospective study was to evaluate the utility of a combined EST and EPLBD method for the removal of common bile duct (CBD) stones that could not be extracted by use of an EST and conventional techniques. METHODS: Between March 2005 and September 2006, a total of 35 patients with CBD stones were enrolled. Fourteen patients had received a previous EST, and 21 patients underwent an EST. The sphincterotomy site was then dilated with a 12~18 mm diameter balloon. RESULTS: The average number of stones was 3.6+/-2.9 (range: 110). The average maximum stone diameter was 26.11+/-8.88 mm (range: 12~50 mm). Complete stone removal was accomplished in 31 patients (88.6%). In 9 patients (25.7%), a mechanical lithotripsy was required. No episode of true pancreatitis occurred. A procedure-related perforation occurred in one patient (2.8%) and the patient was treated with NPO and antibiotics. No procedure-related bleeding or mortality was observed. The procedure was performed safely in 9 patients (25.7%) with a periampullary diverticulum and in 14 patients (40.0%) with a previous EST. CONCLUSIONS: Combined EST and EPLBD may be a safe and effective method, and may be a good alternative treatment for removing CBD stones that cannot be extracted by an EST and conventional techniques. However, prospective studies based on a large number of patients are needed.
