Usefulness of Medium Incision Endoscopic Sphincterotomy with Endoscopic Papillary Balloon Dilatation for the Removal of Common Bile Duct Stones

Ji, Jeong Seon; Chae, Hiun Suk; Kim, Hyung Keun; Cho, Young Seok; Kim, Chang Wook; Lee, Bo In; Choi, Hwang; Kim, Byung Wook; Han, Suk Won; Choi, Kyu Yong

Abstract

BACKGROUND/AIMS: Recent meta-analysis data has shown that there was no significant difference in the rate of overall successful stone removal between endoscopic sphincterotomy (EST) and endoscopic papillary balloon dilatation (EPBD). However, bleeding occurred more frequently in the EST group, and post-ERCP pancreatitis more commonly occurred in the EPBD group. Thus, we hypothesized that medium incision EST modestly combined with EPBD (m-EST+EPBD) could overcome the drawbacks of both techniques.
METHODS
Fifty eight patients who underwent m-EST+EPBD for removal of common bile duct stones were compared with sixty patients who underwent EST only. Medium incision EST was performed with a pure cut mode and then a 12 mm diameter balloon was used for the EPBD.
RESULTS
Complete bile duct stone clearance was achieved in 96.7% of the patients in the EST group and in 96.5% of the patients who underwent m-EST+EPBD (p > 0.05). There was no significant difference between the two groups for procedure-related pancreatitis. The rate for procedure- related hemorrhage was 0% in the both groups.
CONCLUSIONS
m-EST+EPBD showed the possibility of being alternative to EST for the removal of common bile duct stone. To establish effectiveness and safety of m-EST+EPBD, further randomized large scaled clinical studies for comparing EST and m-EST+EPBD are needed.