Published online Nov 7, 2013. doi: 10.3748/wjg.v19.i41.7168
Revised: August 14, 2013
Accepted: August 20, 2013
Published online: November 7, 2013
Processing time: 131 Days and 7.4 Hours
AIM: To evaluate the safety and effectiveness of endoscopic papillary large balloon dilation (EPLBD) for bile duct stone extraction in patients with periampullary diverticula.
METHODS: The records of 223 patients with large common bile duct stones (≥ 10 mm) who underwent EPLBD (12-20 mm balloon diameter) with or without limited endoscopic sphincterotomy (ES) from July 2006 to April 2011 were retrospectively reviewed. Of these patients, 93 (41.7%) had periampullary diverticula (PAD), which was categorized into three types. The clinical variables of EPLBD with limited ES (EPLBD + ES) and EPLBD alone were analyzed according to the presence of PAD.
RESULTS: Patients with PAD were significantly older than those without (75.2 ± 8.8 years vs 69.7 ± 10.9 years, P = 0.000). The rates of overall stone removal and complete stone removal in the first session were not significantly different between the PAD and non-PAD groups, however, there was significantly less need for mechanical lithotripsy in the PAD group (3.2% vs 11.5%, P = 0.026). Overall stone removal rates, complete stone removal rates in the first session and the use of mechanical lithotripsy were not significantly different between EPLBD + ES and EPLBD alone in patients with PAD (96.6% vs 97.1%; 72.9% vs 88.2%; and 5.1% vs 0%, respectively). No significant differences with respect to the rates of pancreatitis, perforation, and bleeding were observed between EPLBD + ES and EPLBD alone in the PAD group (3.4% vs 14.7%, P = 0.095; 0% vs 0%; and 3.4% vs 8.8%, P = 0.351, respectively).
CONCLUSION: EPLBD with limited ES and EPLBD alone are safe and effective modalities for common bile duct stone removal in patients with PAD, regardless of PAD subtypes.
Core tip: Endoscopic papillary large balloon dilation (EPLBD) is a highly effective technique for treating difficult bile duct stones. However, the safety of EPLBD is of concern, especially in patients with periampullary diverticula (PAD). In the present study, the clinical outcomes and complications of EPLBD with limited endoscopic sphincterotomy (ES) (EPLBD + ES) and EPLBD alone according to the presence of PAD were not significantly different. We suggest that EPLBD + ES and EPLBD alone are safe and feasible modalities for large bile duct stone removal in patients with PAD. Furthermore, the presence of PAD was not found to affect therapeutic outcomes.