title: Endoscopic sphincterotomy plus large-balloon dilation versus endoscopic sphincterotomy for removal of bile-duct stones.
abstract: BACKGROUND
  Endoscopic sphincterotomy (EST) to remove bile-duct stones is the most frequently used endoscopic technique. Few reports exist regarding application of large-balloon dilation (LBD) after EST for treatment of patients with bile-duct stones.
  
  
  OBJECTIVE
  To compare the effect of EST plus LBD with that of EST alone.
  
  
  METHODS
  A prospective randomized controlled trial.
  
  
  METHODS
  A large tertiary-referral center.
  
  
  METHODS
  Two hundred consecutive patients with bile-duct stones were randomized in equal numbers to EST plus LBD (12- to 20-mm balloon diameter) or EST alone.
  
  
  METHODS
  Successful stone removal and complications such as pancreatitis and bleeding.
  
  
  RESULTS
  EST plus LBD compared with EST alone resulted in similar outcomes in terms of overall successful stone removal (97.0% vs 98.0%), large size (>15 mm) stone removal (94.4% vs 96.7%), and the use of mechanical lithotripsy (8.0% vs 9.0%). Complications were similar between the 2 groups (5.0% vs 7.0%, P = .767). Complications were as follows for the EST plus LBD group and the EST group: pancreatitis, 4.0% and 4.0%; cholecystitis, 1.0% and 1.0%; and bleeding (delayed), 0% and 2.0%, respectively.
  
  
  CONCLUSIONS
  Based on the similar rates of successful stone removal and complications, EST plus LBD should be an effective alternative to EST. EST plus LBD is a safe and effective treatment for endoscopic removal of common bile duct stones.
authors: Department of Internal Medicine, Pusan National University College of Medicine, Busan, Korea.
authors: Jeung Ho
authors: JH
authors: Heo
authors: Dae Hwan
authors: DH
authors: Kang
authors: Hyo Jin
authors: HJ
authors: Jung
authors: Dae Sik
authors: DS
authors: Kwon
authors: Jin Kwang
authors: JK
authors: An
authors: Bo Suk
authors: BS
authors: Kim
authors: Kyung Duk
authors: KD
authors: Suh
authors: Sang Yong
authors: SY
authors: Lee
authors: Joo Ho
authors: JH
authors: Lee
authors: Gwang Ha
authors: GH
authors: Kim
authors: Tae Oh
authors: TO
authors: Kim
authors: Jeong
authors: J
authors: Heo
authors: Geun Am
authors: GA
authors: Song
authors: Mong
authors: M
authors: Cho
mesh_terms: D002404:Catheterization / Q000295:instrumentation*; D002760:Cholangiopancreatography, Endoscopic Retrograde; D042883:Choledocholithiasis / Q000175:diagnosis / Q000628:therapy*; D004867:Equipment Design; D005260:Female; D005471:Fluoroscopy; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D011446:Prospective Studies; D012720:Severity of Illness Index; D016717:Sphincterotomy, Endoscopic / Q000379:methods*; D016896:Treatment Outcome