Observational Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Dec 28, 2017; 23(48): 8597-8604
Published online Dec 28, 2017. doi: 10.3748/wjg.v23.i48.8597
Endoscopic papillary large balloon dilatation with sphincterotomy is safe and effective for biliary stone removal independent of timing and size of sphincterotomy
Usman Iqbal Aujla, Nimzing Ladep, Laura Dwyer, Stephen Hood, Nicholas Stern, Richard Sturgess
Usman Iqbal Aujla, Nimzing Ladep, Laura Dwyer, Stephen Hood, Nicholas Stern, Richard Sturgess, Digestive Diseases Unit, Aintree University Hospital, Liverpool L9 7AL, United Kingdom
Author contributions: Aujla UI and Sturgess R were responsible for study conception and design; Aujla UI wrote the paper; Ladep N was responsible for data interpretation and statistical analysis; Aujla UI and Dwyer L were responsible for data collection; Hood S, Stern N and Sturgess R critically revised the paper; all authors agreed with content of the manuscript and gave approval of the final version of manuscript.
Informed consent statement: All endoscopic procedures were performed after obtaining a written informed consent form the patients.
Conflict-of-interest statement: The authors have no disclosures.
Data sharing statement: Being a descriptive study no additional data is available to warrant 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: Dr. Usman Iqbal Aujla, FRCP, Digestive Diseases Unit, Aintree University Hospital, NHS Foundation Trust, Longmoor Lane, Liverpool L9 7AL, United Kingdom. usman.aujla@nhs.net
Telephone: +44-786-1884248 Fax: +44-151-5292809
Received: August 14, 2017
Peer-review started: August 15, 2017
First decision: August 29, 2017
Revised: October 31, 2017
Accepted: November 14, 2017
Article in press: November 14, 2017
Published online: December 28, 2017
Research background

Endoscopic papillary large balloon dilatation (EPLBD) is an established technique for biliary stone extraction mainly in Asia. Serious adverse events related to EPLBD including pancreatitis, bleeding and perforation have limited its wider utility particularly in the Western world. Timing and size of preceding endoscopic sphincterotomy (EST) impose significant concerns regarding serious procedure related adverse events. This study describes the safety and efficacy of EPLBD in the management of CBDS and examines the impact of timing and size of sphincteroplasty in relation to EST in a Western population.

Research motivation

EPLBD is being performed very frequently in day to day practice. There is insufficient data on its efficacy and safety without any standardized techniques. There is little data on timing and hence an appreciation that there is variation in practice in some centres performing a sphincteroplasty on a subsequent and further endoscopic retrograde cholangiopancreatography. The principal motive of the study was to ascertain whether EPLBD could be performed safely as an effective and preferred endoscopic modality for complex biliary stone extraction following EST.

Research objectives

The main objectives of the study were to describe the efficacy and safety of EPLBD in the management of bile duct stones in a Western population from the experience in a busy tertiary referral unit.

Research methods

This was a retrospective observational study in which consecutive patients who underwent EPLBD during the defined period were evaluated based on study endpoints.

Research results

This study confers high safety profile of EPLBD for biliary stone extraction in relation to an EST. The study also ascertains EPLBD as an effective and preferred endoscopic modality than standard endoscopic techniques for complex bile duct stones management. The problems that remain to be solved are the predictive factors indicating the need for EPLBD and factors predicting failure.

Research conclusions

EPLBD is a safe and effective technique for biliary stone extraction. Safety of large balloon sphincteroplasty is not influenced by the presence of a periampullary diverticulum or a fresh sphincterotomy. Limited or full sphincterotomy followed by EPLBD does not influence the outcomes. Large and multiple stones may predict need for additional treatment modalities including cholangioscopy and electrohydraulic lithotripsy where large balloon sphincteroplasty remains unsuccessful in achieving duct clearance.

Research perspectives

This study suggests that large balloon sphincteroplasty can be performed and repeated safely and effectively in those with a sphincterotomy irrespective of its timing and size to establish complete duct clearance.