Korean J Gastroenterol.  2011 Oct;58(4):201-207. 10.4166/kjg.2011.58.4.201.

The Effect of Periampullary Diverticulum on the Outcome of Bile Duct Stone Treatment with Endoscopic Papillary Large Balloon Dilation

• Lee JW
• Kim JH
• Kim YS
• Choi HS
• Kim JS
• Jeong SH
• Ha MS
• Ku YS
• Kim YS
• Kim JH

• KMID: 1718428
• DOI: http://doi.org/10.4166/kjg.2011.58.4.201

Abstract

BACKGROUND/AIMS
Periampullary diverticulum (PAD) causes difficulty in the extraction of common bile duct (CBD) stones with conventional endoscopic therapy. Our study was designed to evaluate the effect of PAD on endoscopic large balloon dilation (EPLBD) with/without limited endoscopic sphincterotomy (EST) for CBD stone treatment.
METHODS
We retrospectively reviewed cases of 141 patients treated CBD stones by EPLBD with/without limited EST at Gachon Gil Medical Center from September 2008 to February 2010. PAD were classified into three groups according to the location of the papilla and diverticulum. Clinical parameters, endoscopic parameters, and procedure outcomes were analyzed.
RESULTS
PAD were identified in 46.1% (65/141), with 23 male (35.4%) and 42 female (64.6%) and a mean age of 72.9+/-11.1 years. Mean diameter of the stones was 14.8+/-6.0 mm and mean diameter of CBD was 21.6+/-7.7 mm. PAD group was significantly older than control group (72.9 vs. 68.6, p=0.043) and the incidence of large stone (> or =15 mm) was higher in PAD group (60.0% vs. 42.1%, p=0.034). Success rate of complete removal of stones in the first session was 32/65 patients (49.2%) and overall successful complete stone removal rates was 63/65 (96.9%). There was no significant difference between the PAD and control groups in success rate. Major complications were similar between two groups.
CONCLUSIONS
PAD is associated with an increased incidence of large bile duct stones and older age. PAD seems to not increase technical failure rate or complication risk on EPLBD with/without limited EST.

Keyword

Diverticulum; Common bile duct; Choledocholithiasis; Balloon dilation; Endoscopic sphincterotomy

MeSH Terms

Age Factors
Aged
Aged, 80 and over
*Balloon Dilation
Cholangiopancreatography, Endoscopic Retrograde
Common Bile Duct/anatomy & histology
Diverticulum/*diagnosis
Duodenal Diseases/*diagnosis
Female
Gallstones/surgery/*therapy
Humans
Male
Middle Aged
Retrospective Studies
Treatment Outcome

Reference

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