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KMID : 0882420070730050474
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Korean Journal of Medicine
2007 Volume.73 No. 5 p.474 ~ p.480
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Combined endoscopic sphincterotomy and large balloon sphincteroplasty for bile duct stones
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Kim Min-Kyoung
Kim Myung-Hwan
Lee Tae-Yoon
Oh Hyoung-Chul
Kwon Seung-Hyun
Han Jung-Hye
Choi Hyung-Oh
Park Soo-Jung
Kim Tae-Hyup
Lee Sang-Soo
Seo Dong-Wan
Lee Sung-Koo
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Abstract
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Background : The combined use of small endoscopic sphincterotomy (EST) followed by endoscopic papillary large balloon dilation (EPLBD) might be associated with a lower incidence of procedure-related complications such as pancreatitis, bleeding or perforation, compared to the use of EPLBD or a large EST alone. The aim of this retrospective study was to evaluate the utility of a combined EST and EPLBD method for the removal of common bile duct (CBD) stones that could not be extracted by use of an EST and conventional techniques.
Methods : Between March 2005 and September 2006, a total of 35 patients with CBD stones were enrolled. Fourteen patients had received a previous EST, and 21 patients underwent an EST. The sphincterotomy site was then dilated with a 12~18 mm diameter balloon.
Results : The average number of stones was 3.6+/-2.9 (range: 110). The average maximum stone diameter was 26.11+/-8.88 mm (range: 12~50 mm). Complete stone removal was accomplished in 31 patients (88.6%). In 9 patients (25.7%), a mechanical lithotripsy was required. No episode of true pancreatitis occurred. A procedure-related perforation occurred in one patient (2.8%) and the patient was treated with NPO and antibiotics. No procedure-related bleeding or mortality was observed. The procedure was performed safely in 9 patients (25.7%) with a periampullary diverticulum and in 14 patients (40.0%) with a previous EST.
Conclusion : Combined EST and EPLBD may be a safe and effective method, and may be a good alternative treatment for removing CBD stones that cannot be extracted by an EST and conventional techniques. However, prospective studies based on a large number of patients are needed.
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KEYWORD
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Endoscopic sphincterotomy, Endoscopic papillary large balloon dilation, Common bile duct stone
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