Endoscopic sphincterotomy plus large-balloon dilation versus endoscopic sphincterotomy for removal of bile-duct stones.
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.
Heo
Jeung Ho
JH
Department of Internal Medicine, Pusan National University College of Medicine, Busan, Korea.
Kang
Dae Hwan
DH
Jung
Hyo Jin
HJ
Kwon
Dae Sik
DS
An
Jin Kwang
JK
Kim
Bo Suk
BS
Suh
Kyung Duk
KD
Lee
Sang Yong
SY
Lee
Joo Ho
JH
Kim
Gwang Ha
GH
Kim
Tae Oh
TO
Heo
Jeong
J
Song
Geun Am
GA
Cho
Mong
M
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