Clin Endosc.  2013 Nov;46(6):637-642.

Late Complications and Stone Recurrence Rates after Bile Duct Stone Removal by Endoscopic Sphincterotomy and Large Balloon Dilation are Similar to Those after Endoscopic Sphincterotomy Alone

• Kim KY
• Han J
• Kim HG
• Kim BS
• Jung JT
• Kwon JG
• Kim EY
• Lee CH

Abstract

BACKGROUND/AIMS
Between endoscopic sphincterotomy (ES) alone and combined endoscopic sphincterotomy and large balloon dilation (ES-LBD) groups, efficacy and long-term complications, difference in biliary stone recurrence rate, and risk factors of stone recurrence were compared.
METHODS
Medical records of 222 patients who underwent ERCP for biliary stone removal were retrospectively reviewed. Patients with dilated CBD > or =11 mm and follow-up longer than 6 months were included.
RESULTS
There were 101 patients in ES-LBD group and 121 patients in ES group. Mean follow-up duration was 25.0 (6-48) months and 13.0 (6-43) months, respectively (p=0.001). There was no difference in number of ERCP sessions, brown pigment stones, angle between mid and distal common bile duct (CBD angle) <135degrees, and lithotripsy rate. Complete retrieval success rate was excellent in both groups (100% vs. 99%). Early complication rate of ES-LBD and ES alone group was 4 and 4.1%, respectively (p=1.000). One patient in ES-LBD group died from delayed bleeding. Late complication rate was 5.9 and 3.3%, respectively (p=1.000). Stone recurrence rate was 6.9% and 5.8%, respectively (p=0.984). The only Independent risk factor of stone recurrence was presence of periampullary diverticulum.
CONCLUSIONS
Late complication and stone recurrence rates were similar between ES-LBD and ES alone groups.

Keyword

Common bile duct stone; Sphincterotomy, endoscopic; Endoscopic large balloon dilation; Stone recurrence; Late complication

MeSH Terms

Bile Ducts*
Bile*
Cholangiopancreatography, Endoscopic Retrograde
Common Bile Duct
Follow-Up Studies
Hemorrhage
Humans
Lithotripsy
Medical Records
Recurrence*
Retrospective Studies
Risk Factors
Sphincterotomy, Endoscopic*

Figure

• 

  Fig. 1 Measurement of the common bile duct angle. The first angulation from the ampullary orifice is measured on a cholangiogram obtained in the prone position.

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