Retrospective Cohort Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Aug 21, 2017; 23(31): 5739-5745
Published online Aug 21, 2017. doi: 10.3748/wjg.v23.i31.5739
Minor endoscopic sphincterotomy followed by large balloon dilation for large choledocholith treatment
Xiao-Dan Xu, Bo Chen, Jian-Jun Dai, Jian-Qing Qian, Chun-Fang Xu
Xiao-Dan Xu, Bo Chen, Jian-Jun Dai, Jian-Qing Qian, Department of Gastroenterology, Changshu Affiliated Hospital of Soochow University, Changshu 215500, Jiangsu Province, China
Chun-Fang Xu, Department of Gastroenterology, the First Affiliated Hospital of Soochow University, Soozhou 215000, Jiangsu Province, China
Author contributions: Chen B, Dai JJ and Qian JQ performed the majority of experiments; Xu XD and Qian JQ contributed analytic tools and analyzed the data; Xu CF designed the research and Xu XD wrote the paper.
Supported by Project of Jiangsu Provincial Medical Youth Talent, No. QNRC2016213; Soochow Special Project for Major Clinical Diseases, No. LCZX201319; and Science and Technology Bureau of Changshu, No. CS201501.
Institutional review board statement: This study was reviewed and approved by the Institutional Review Board of Changshu Hospital Affiliated to Soochow University, Changshu, China.
Informed consent statement: All study participants or their legal guardian provided informed written consent about personal and medical data collection prior to study enrollment.
Conflict-of-interest statement: The authors declare no conflict of interest.
Data sharing statement: Technical appendix, statistical code and dataset available from the corresponding author at xxd20@163.com. Participants gave informed consent for data sharing.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Xiao-Dan Xu, MD, Department of Gastroenterology, Changshu Affiliated Hospital of Soochow University, No. 1, Shuyuan Street, Changshu 215500, Jiangsu Province, China. xuxiaodan@jscsyy.cn
Telephone: +86-189-13631835 Fax: +86-512-52160115
Received: April 10, 2017
Peer-review started: April 12, 2017
First decision: May 12, 2017
Revised: May 29, 2017
Accepted: July 12, 2017
Article in press: July 12, 2017
Published online: August 21, 2017
Abstract
AIM

To evaluate early and late outcomes of endoscopic papillary large balloon dilation (EPLBD) with minor endoscopic sphincterotomy (mEST) for stone removal.

METHODS

A total of 149 consecutive patients with difficult common bile duct (CBD) stones (diameter ≥ 10 mm or ≥ 3 stones) underwent conventional endoscopic sphincterotomy (EST) or mEST plus EPLBD from May 2012 to April 2016. Their demographic, laboratory and procedural data were collected, and pancreaticobiliary complications were recorded.

RESULTS

Sixty-nine (94.5%) of the patients in the EPLBD + mEST group and 64 (84.2%) in the conventional EST group achieved stone clearance following the first session (P = 0.0421). The procedure time for EPLBD + mEST was shorter than for EST alone (42.1 ± 13.6 min vs 47.3 ± 11.8 min, P = 0.0128). The overall rate of early complications in the EPLBD + mEST group (11%) was lower than in the EST group (21.1%); however, the difference was not significant (P = 0.0938). The cumulative recurrence rate of cholangitis and CBD stones between the two groups was also similar. The procedure time was independently associated with post-endoscopic retrograde cholangiopancreatography pancreatitis (OR = 6.374, 95%CI: 1.193-22.624, P = 0.023), CBD stone diameter ≥ 16 mm (OR = 7.463, 95%CI: 2.705-21.246, P = 0.0452) and use of mechanical lithotripsy (OR = 9.913, 95%CI: 3.446-23.154, P = 0.0133) were independent risk factors for stone recurrence.

CONCLUSION

EPLBD with mEST is more effective than EST alone for difficult CBD stone removal, with shorter procedure time and fewer early complications.

Keywords: Endoscopic papillary balloon dilation, Pancreatitis, Endoscopic sphincterotomy, Common bile duct stones

Core tip: This is a retrospective comparative study to investigate the efficacy and safety of endoscopic papillary large balloon dilation (EPLBD) with minor endoscopic sphincterotomy (mEST) for the removal of difficult common bile duct stones. EPLBD + mEST was found to be more effective than conventional endoscopic sphincterotomy alone for difficult stone removal, with shorter procedure time and potentially fewer early complications.