What is an appropriate indication for endoscopic papillary balloon dilation?
OBJECTIVE
There are a number of views on the indication for endoscopic papillary balloon dilation (EPBD) in the management of bile duct stones. In this study, we have evaluated the efficacy and safety of EPBD compared with endoscopic sphincterotomy (EST).


METHODS
Prospective randomized trial.


METHODS
One university hospital and one general hospital.


METHODS
One hundred and forty patients were randomly allocated to EPBD or EST. Outcomes and complications were observed for a median period of 30 months.


RESULTS
Both treatment approaches finally achieved similar success rates and needed similar numbers of treatment sessions for patients with stones less than 10 mm in diameter. However, for patients with stones of 10 mm or more, EPBD required a significantly greater mean number of treatment sessions than EST (2.4 vs 1.6, P < 0.01). Early complications occurred in seven EPBD (four pancreatitis, two cholangitis and one basket impaction) and eight EST (three pancreatitis, two bleeding and three cholangitis) patients. Late complications occurred in four EPBD (three recurrent bile duct stones and one cholecystitis) and six EST (three recurrent stones and three cholecystitis) patients.


CONCLUSIONS
EPBD has little risk of bleeding. The technique removed small bile duct stones just as easily as did EST. These two procedures had approximately the same risk of pancreatitis and incidence of recurrent bile duct stones. Therefore, both procedures appear to be appropriate treatments for small bile duct stones. Whether or not EPBD becomes an established treatment will depend on further long-term studies.
Natsui
Masaaki
M
Department of Internal Medicine, Niigata Prefectural Shibata Hospital, Shibata, Japan.
Narisawa
Rintaro
R
Motoyama
Hirotaka
H
Hayashi
Shun-Ichi
S
Seki
Keiichi
K
Wakabayashi
Hiroto
H
Itoh
Shin-Ichi
S
Asakura
Hitoshi
H
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014670:Ampulla of Vater; D002404:Catheterization / Q000009:adverse effects / Q000379:methods; D002764:Cholecystitis / Q000209:etiology; D002769:Cholelithiasis / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010195:Pancreatitis / Q000209:etiology; D011446:Prospective Studies; D012008:Recurrence; D012449:Safety; D016717:Sphincterotomy, Endoscopic / Q000009:adverse effects; D016896:Treatment Outcome