Small sphincterotomy combined with papillary dilation with large balloon permits retrieval of large stones without mechanical lithotripsy.
OBJECTIVE
To introduce a new method: small endoscopic sphincterotomy (ES) combined with endoscopic papillary large balloon dilation (SES + EPLBD) to treat patients with large biliary stones.


METHODS
Retrieval of large biliary stones was performed in 88 patients. Mean stone size was 14 +/- 3 mm and mean number of stones was 2.5 +/- 3.5. Firstly, ES with a small incision was performed. Next, endoscopic papillary dilation was performed with a large balloon to slowly match the size of the bile duct. Stones were then retrieved from the biliary duct with a balloon and a basket.


RESULTS
Stone retrieval was successful in all cases except one cystic duct stone case without the need to crush large stones. Mean procedure time was 30 +/- 5 min. Dilating the papillary orifice with a large balloon made it possible to remove large stones smoothly without crushing them. After dilation with the large balloon, there were some instances of oozing, but no perforations. One instance of post-procedural pancreatitis (1%) occurred.


CONCLUSIONS
SES + EPLBD was effective for the retrieval of large biliary stones without the use of mechanical lithotripsy.
Minami
Atsushi
A
Kawasaki Kyodo Hospital 2-1-5 Sakuramoto Kawasaki City 210-0833, Japan. minamia@d1.dion.ne.jp
Hirose
Shinji
S
Nomoto
Tomohiro
T
Hayakawa
Shoichiro
S
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002404:Catheterization / Q000009:adverse effects / Q000379:methods*; D002760:Cholangiopancreatography, Endoscopic Retrograde; D005260:Female; D042882:Gallstones / Q000175:diagnosis / Q000473:pathology / Q000628:therapy*; D006801:Humans; D008096:Lithotripsy / Q000379:methods; D008297:Male; D008875:Middle Aged; D016717:Sphincterotomy, Endoscopic / Q000009:adverse effects / Q000379:methods*