title: Sequential endoscopic papillary balloon dilatation following limited sphincterotomy for common bile duct stones.
abstract: Endoscopic papillary balloon dilatation (EPBD) has been recently used in conjunction with endoscopic sphincterotomy (EST) for the removal of common bile duct (CBD) stones. The present study was aimed at assessing the safety and outcome of sequential EPBD following EST for CBD stones. A total of 74 patients (43 females, mean age 41 years) with > or = 10-mm stone(s) in the CBD were selected for the procedure, which included limited EST followed by EPBD with balloon dilators of 10-18 mm in size. Eleven patients had undergone EST and unsuccessful stone removal earlier. Forty-nine patients had symptoms of CBD stones, while 25 were detected on imaging. Eleven patients had previous CBD stent in situ and four had T-tube in situ. The stone size was 10-12 mm in 34, 13-14 mm in 26, and > or = 15 mm in 14 patients. Thirty-one patients had a single stone, while 43 had > or = 2 stones. The successful removal of stones was achieved in 68 (91.9%) patients; 62 in the first attempt, five in the second, and one in the third. Six patients were deemed to be "failures." In two of them, the stones could be removed after mechanical lithotripsy. Complications were seen in 16 patients, with self-limiting pain in 13, self-limiting ooze in five, melaena in one, and mild pancreatitis in two. One patient had impaction of the dormia basket. We conclude that EPBD following EST is safe and effective in removing stones > or = 10 mm in size in over 90% of patients.
authors.affiliation: Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India. dr_kochhar@hotmail.com
authors.forename: Rakesh
authors.initials: R
authors.lastname: Kochhar
authors.forename: Usha
authors.initials: U
authors.lastname: Dutta
authors.forename: Rajat
authors.initials: R
authors.lastname: Shukla
authors.forename: Birinder
authors.initials: B
authors.lastname: Nagi
authors.forename: Kartar
authors.initials: K
authors.lastname: Singh
authors.forename: Jai D
authors.initials: JD
authors.lastname: Wig
mesh_terms: D000328:Adult; D000368:Aged; D002404:Catheterization / Q000379:methods*; D005260:Female; D042882:Gallstones / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019233:Retreatment; D016717:Sphincterotomy, Endoscopic; D016896:Treatment Outcome