Journal Article

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

Shinpei Doi, Kensaku Yoshida, Mitsuru Okuno, Shinya Uemura, Ichiro Yasuda, Tsuyoshi Mukai, Nobuhiro Ando, Masatoshi Mabuchi, Masanori Nakashima, Seiji Adachi, Akinori Maruta, Yohei Horibe, Masahito Shimizu, Takuji Iwashita, Keisuke Iwata

2016

Overview

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.

• Publisher: Springer Science and Business Media LLC,Springer US,Springer,Springer Nature B.V
• Subject: Aged / Aged, 80 and over / Analysis / Biochemistry / Cholangiopancreatography, Endoscopic Retrograde / Cholangiopancreatography, Endoscopic Retrograde - adverse effects / Cholangiopancreatography, Endoscopic Retrograde - methods / Cholelithiasis / Cholelithiasis - surgery / Combined Modality Therapy / Dilatation / Dilatation - instrumentation / Dilatation - methods / Female / Gastroenterology / Hepatology / Humans / Lithotripsy / Male / Medicine / Medicine & Public Health / Oncology / Original Article / Pancreatitis / Pneumoviridae / Postoperative Complications / Retrospective Studies / Sphincterotomy, Endoscopic / Sphincterotomy, Endoscopic - instrumentation / Sphincterotomy, Endoscopic - methods / Transplant Surgery / Treatment Outcome