Endoscopic papillary balloon dilatation in comparison with endoscopic sphincterotomy for the treatment of large common bile duct stone

Authors

1 Department of Internal Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

2 Department of General Surgery, Isfahan University of Medical Sciences, Isfahan, Iran

Abstract

Background: There are concerns on the efficacy and safety of endoscopic papillary balloon dilatation (EPBD) as an alternative to endoscopic sphincterotomy (EST) in the treatment of choledocholithiasis. We compared the efficacy and safety of EPBD and EST for removing large common bile duct (CBD) stones.
Materials and Methods: One hundred sixty patients with CBD stones of 10-20 mm were randomized to undergo EPBD or EST. A 15-mm dilatation balloon was used for EPBD. Cotton's criteria were used to determine the incidence of post-EPBD or post-EST complications. CBD stone removal and complications were compared between the two methods.
Results: CBD stones were completely removed in 97.5% of the EPBD and 96.2% of the EST group ( P = 0.5). The incidence of postoperative pancreatitis (11.2% vs 8.7%) and bleeding (1.2% vs 1.2%) were similar between the EPBD and EST groups ( P > 0.05). Perforation did not occur in any patient.
Conclusions: EPBD with 15-mm dilator balloon appears to be equally safe and effective compared with EST for removal of large CBD stones. So because of low complication and high success rate we recommend EPBD as the preferred method for removal of large (10-20 mm) CBD stones.

Keywords

1. Yoo KS, Lehman GA. Endoscopic management of biliary ductal stones. Gastroenterol Clin North Am 2010;39:209-27, viii, [doi: 10.1016/j.gtc.2010.02.008].  Back to cited text no. 1
    
2. Freeman ML, Nelson DB, Sherman S, Haber GB, Herman ME, Dorsher PJ, et al. Complications of endoscopic biliary sphincterotomy. N Engl J Med 1996;335:909-18.  Back to cited text no. 2
    
3. Aiura K, Kitagawa Y. Current status of endoscopic papillary balloon dilation for the treatment of bile duct stones. J Hepatobiliary Pancreat Sci 2011;18:339-45.  Back to cited text no. 3
    
4. Baron TH, Harewood GC. Endoscopic balloon dilation of the biliary sphincter compared to endoscopic biliary sphincterotomy for removal of common bile duct stones during ERCP: A metaanalysis of randomized, controlled trials. Am J Gastroenterol 2004;99:1455-60.  Back to cited text no. 4
    
5. Yasuda I, Tomita E, Enya M, Kato T, Moriwaki H. Can endoscopic papillary balloon dilation really preserve sphincter of Oddi function? Gut 2001;49:686-91.  Back to cited text no. 5
    
6. Tsujino T, Kawabe T, Komatsu Y, Yoshida H, Isayama H, Sasaki T, et al. Endoscopic papillary balloon dilation for bile duct stone: Immediate and long-term outcomes in 1000 patients. Clin Gastroenterol Hepatol 2007;5:130-7.  Back to cited text no. 6
    
7. Sugiyama M, Izumisato Y, Abe N, Masaki T, Mori T, Atomi Y. Predictive factors for acute pancreatitis and hyperamylasemia after endoscopic papillary balloon dilation. Gastrointest Endosc 2003;57:531-5.  Back to cited text no. 7
    
8. Komatsu Y, Kawabe T, Toda N, Ohashi M, Isayama M, Tateishi K, et al. Endoscopic papillary balloon dilation for the management of common bile duct stones: Experience of 226 cases. Endoscopy 1998;30:12-7.  Back to cited text no. 8
    
9. Sugiyama M, Abe N, Izumisato Y, Masaki T, Mori T, Atomi Y. Risk factors for acute pancreatitis after endoscopic papillary balloon dilation. Hepatogastroenterology 2003;50:1796-8.  Back to cited text no. 9
    
10. Hong WD, Zhu QH, Huang QK. Endoscopic sphincterotomy plus endoprostheses in the treatment of large or multiple common bile duct stones. Dig Endosc 2011;23:240-3.  Back to cited text no. 10
    
11. Watanabe H, Yoneda M, Tominaga K, Monma T, Kanke K, Shimada T, et al. Comparison between endoscopic papillary balloon dilatation and endoscopic sphincterotomy for the treatment of common bile duct stones. J Gastroenterol 2007;42:56-62.  Back to cited text no. 11
    
12. Fujita N, Maguchi H, Komatsu Y, Yasuda I, Hasebe O, Igarashi Y, et al. Endoscopic sphincterotomy and endoscopic papillary balloon dilatation for bile duct stones: A prospective randomized controlled multicenter trial. Gastrointest Endosc 2003;57:151-5.  Back to cited text no. 12
    
13. Disario JA, Freeman ML, Bjorkman DJ, Macmathuna P, Petersen BT, Jaffe PE, et al. Endoscopic balloon dilation compared with sphincterotomy for extraction of bile duct stones. Gastroenterology 2004;127:1291-9.  Back to cited text no. 13
    
14. Gerke H, Baillie J. To cut or stretch? Am J Gastroenterol 2004;99:1461-3.  Back to cited text no. 14
    
15. Cotton PB, Lehman G, Vennes J, Geenen JE, Russell RC, Meyers WC, et al. Endoscopic sphincterotomy complications and their management: An attempt at consensus. Gastrointest Endosc 1991;37:383-93.  Back to cited text no. 15
    
16. Sato H, Kodama T, Takaaki J, Tatsumi Y, Maeda T, Fujita S, et al. Endoscopic papillary balloon dilatation may preserve sphincter of Oddi function after common bile duct stone management: Evaluation from the viewpoint of endoscopic manometry. Gut 1997;41:541-4.  Back to cited text no. 16
    
17. Yasuda I, Fujita N, Maguchi H, Hasebe O, Igarashi Y, Murakami A, et al. Long-term outcomes after endoscopic sphincterotomy versus endoscopic papillary balloon dilation for bile duct stones. Gastrointest Endosc 2010;72:1185-91.  Back to cited text no. 17
    
18. Tanaka S, Sawayama T, Yoshioka T. Endoscopic papillary balloon dilation and endoscopic sphincterotomy for bile duct stones: Long-term outcomes in a prospective randomized controlled trial. Gastrointest Endosc 2004;59:614-8.  Back to cited text no. 18
    
19. Liu Y, Su P, Lin S, Xiao K, Chen P, An S, et al. Endoscopic papillary balloon dilatation vs endoscopic sphincterotomy in the treatment for choledocholithiasis: A meta-analysis. J Gastroenterol Hepatol 2012;27:464-71.  Back to cited text no. 19
    
20. Tsujino T, Isayama H, Komatsu Y, Ito Y, Tada M, Minagawa N, et al. Risk factors for pancreatitis in patients with common bile duct stones managed by endoscopic papillary balloon dilation. Am J Gastroenterol 2005;100:38-42.  Back to cited text no. 20
    
21. Ueno N, Ozawa Y. Pancreatitis induced by endoscopic balloon sphincter dilation and changes in serum amylase levels after the procedure. Gastrointest Endosc 1999;49:472-6.  Back to cited text no. 21
    
22. Sugiyama M, Atomi Y, Kuroda A, Muto T. Treatment of choledocholithiasis in patients with liver cirrhosis. Surgical treatment or endoscopic sphincterotomy? Ann Surg 1993;218:68-73.  Back to cited text no. 22
    
23. Moreira VF, Arribas R, Sanroman AL, Meroño E, Larena C, Garcia M, et al. Choledocholithiasis in cirrhotic patients: Is endoscopic sphincterotomy the safest choice? Am J Gastroenterol 1991;86:1006-10.  Back to cited text no. 23
    
24. Park DH, Kim MH, Lee SK, Lee SS, Choi JS, Song MH, et al. Endoscopic sphincterotomy vs. endoscopic papillary balloon dilation for choledocholithiasis in patients with liver cirrhosis and coagulopathy. Gastrointest Endosc 2004;60:180-5.  Back to cited text no. 24