Minor endoscopic sphincterotomy followed by large balloon dilation for large choledocholith treatment

Table 1 Baseline characteristics of patients

Variable	EPLBD + mEST	EST	P value
	n = 73	n = 76
Age in yr	59.7 ± 12.4	62.1 ± 13.7	0.2647
Sex, male/female	47/26	45/31	0.5160
Cholecystolithiasis	22 (30.1)	19 (25)	0.4828
Cirrhosis	5 (6.8)	6 (7.9)	0.8073
History of cholecystectomy	7 (9.6)	7 (9.2)	0.9369
Periampullary diverticulum	9 (12.3)	11 (14.5)	0.7010
Billroth II gastrectomy	2 (2.7)	3 (3.9)	0.9635
AMY in U/L	84.1 ± 21.9	90.1 ± 24.3	0.1160
TB in mg/dL	4.9 ± 2.1	5.3 ± 2.6	0.3007
ALT in IU/L	121.8 ± 27.6	117.3 ± 37.2	0.4005
AST in IU/L	91.1 ± 27.7	95.6 ± 31.3	0.3550
PT in s	11.2 ± 2.1	11.7 ± 2.3	0.1684
PC as × 106/L	157.2 ± 31.3	158.1 ± 31.2	0.8896
Maximum CBD diameter in mm	17.5 ± 4.6	18.1 ± 5.7	0.4817
Maximum stone diameter in mm	16.9 ± 4.1	16.5 ± 4.7	0.5813
CBD stones	2.9 ± 1.1	2.3 ± 1.9	0.4354

Data are presented as n (%) or mean ± SD. ALT: Alanine aminotransferase; AMY: Serum amylase level; AST: Aspartate aminotransferase; CBD: Common bile duct; EPLBD: Endoscopic papillary large balloon dilation; EST: Endoscopic sphincterotomy; LC: Leukocyte count; mEST: EST: Endoscopic sphincterotomy; PC: Platelet count; PT: Prothrombin time; TB: Total serum bilirubin.

Table 2 Outcomes of endoscopic papillary large balloon dilation + minor endoscopic sphincterotomy for stone removal compared with endoscopic sphincterotomy alone

Outcome	EPLBD + mEST	EST	P value
	n = 73	n = 76
Stone removal succeeded without MLT	68 (93.2)	62 (81.6)	0.0343
Procedure time in min	42.1 ± 13.6	47.3 ± 11.8	0.0128
Initial success	69 (94.5)	64 (84.2)	0.0421
Overall success	73 (100)	76 (100)	-
ENBD placement time in d	2.6 ± 0.7	2.5 ± 0.6	0.3990
Duration of hospital stay in d	5.1 ± 2.2	5.7 ± 1.9	0.0753
Early complications	8 (11.0)	16 (21.1)	0.0938
PEP	6 (8.2)	7 (9.2)	0.8303
Mild	6	7	0.8303
Moderate	0	0	-
Severe	0	0	-
Cholangitis	1 (1.4)	3 (4.0)	0.6411
Hemorrhage		0	-
Intraprocedural	1 (1.4)	6 (7.9)	0.1351
Post-procedural	0	0	-
Perforation	0	0	-
Late complications	4 (5.5)	4 (5.2)	0.7604
Recurrence of cholangitis	0	1 (1.3)	1.0000
Recurrence of CBD stones	4 (5.5)	3 (3.9)	0.9565
CBD stricture	0	0	-
Duration of follow-up in mo	14.1 ± 5.5	12.9 ± 5.5	0.2140
Cholecystectomy	5 (6.8)	7 (9.2)	0.5965
Loss to follow-up	0	0	-
Death	0	0	-

Data are presented as n (%) or mean ± SD. CBD: Common bile duct; ENBD: Endoscopic nasobiliary drainage; EPLBD: Endoscopic papillary large balloon dilation; EST: Endoscopic sphincterotomy; mEST: Minor endoscopic sphincterotomy; MLT: Mechanical lithotripsy; PEP: Post-endoscopic retrograde cholangiopancreatography pancreatitis.

Table 3 Univariate analysis of risk factors for post-endoscopic retrograde cholangiopancreatography pancreatitis and stone recurrence

Variable	PEP	No-PEP	P value	Stone recurrence n = 7	No-stone recurrence n =142	P value
	n =13	n =136
Age in yr	60.3 ± 10.7	61.1 ± 11.3	0.8069	59.6 ± 11.4	60.7 ± 9.9	0.7760
Sex, male/female	8/5	84/52	0.7775	5/2	87/55	0.8873
Cholecystolithiasis	2 (15.4)	39 (28.7)	0.4838	1 (14.3)	40 (28.2)	0.7118
History of cholecystectomy	1 (7.7)	13 (9.6)	0.7817	1 (14.3)	14 (9.9)	0.5319
Periampullary diverticulum	0	20 (14.7)	0.2891	2 (28.6)	18 (12.7)	0.2378
Billroth II gastrectomy	1 (7.7)	4 (2.9)	0.3706	0	5 (3.5)	1.0000
Procedure time in min	51.3 ± 11.7	43.6 ± 12.5	0.0346	50.1 ± 10.8	48.1 ± 11.1	0.6420
Maximum CBD diameter in mm	17.1 ± 5.3	16.7 ± 4.9	0.7804	18.7 ± 8.1	16.7 ± 7.7	0.5043
Maximum stone diameter in mm	17.3 ± 5.1	16.9 ± 6.1	0.8194	19.9 ± 7.7	15.3 ± 5.1	0.0246
≥ 16	7 (53.8)	23 (16.9)	0.0049	4 (57.1)	26 (18.3)	0.0435
≥ 22	2	3	0.0607	1 (14.3)	4 (2.8)	0.2165
No. of CBD stones	2.4 ± 1.2	2.2 ± 1.0	0.4995	2.1 ± 1.1	1.9 ± 1.0	0.6071
MLT performed	3 (23.1)	16 (11.7)	0.4635	4 (57.1)	15 (10.6)	0.0053
Dilating procedure performed	6 (46.2)	67 (49.3)	0.8303	4 (57.1)	69 (48.6)	0.6586
ENBD placement time in d	2.3 ± 0.5	2.6 ± 0.7	0.0960	2.8 ± 0.7	2.6 ± 0.7	0.5010

Data are presented as n (%) or mean ± SD. CBD: Common bile duct; ENBD: Endoscopic nasobiliary drainage; EPLBD: Endoscopic papillary large balloon dilation; mEST: Minor endoscopic sphincterotomy; MLT: Mechanical lithotripsy; PEP: Post-endoscopic retrograde cholangiopancreatography pancreatitis.