title: Endoscopic large-balloon sphincteroplasty without preceding sphincterotomy for the removal of large bile duct stones: a preliminary study.
abstract: BACKGROUND
  Endoscopic sphincterotomy (EST) has usually been performed before large-balloon sphincteroplasty (LBS) to retrieve large bile duct stones because of the high risk of pancreatitis and some advantages of EST. However, there are no available data on the preceding EST to confirm these assertions.
  
  
  OBJECTIVE
  We investigated the safety and efficacy of LBS without a preceding EST for the management of large bile duct stones.
  
  
  METHODS
  Single-institution retrospective study.
  
  
  METHODS
  Tertiary referral center.
  
  
  METHODS
  Thirty-eight patients with large bile duct stones.
  
  
  METHODS
  Endoscopic LBS without preceding EST.
  
  
  METHODS
  Efficacy of stone removal and complications related to the procedure.
  
  
  RESULTS
  The overall success rate irrespective of whether mechanical lithotripsy (ML) was used was 97.4% (37/38). Complete duct clearance by LBS alone without ML was achieved in 29 (76.3%) patients. Complete stone retrieval was achieved by LBS alone in the first session in 25 (65.8%) patients. ML was required in 8 (21.1%) patients. Failure to extract a stone occurred in 1 (2.6%) patient. There was a mild degree of postprocedure pancreatitis in only 1 (2.6%) patient and asymptomatic hyperamylasemia in 3 (7.9%) patients. The maximum diameters of the stones and the balloon/stone diameter ratio had a tendency to affect complete stone retrieval in the success and failure groups: 16.7 +/- 3.9 mm vs 20.8 +/- 6.5 mm and 0.96 +/- 0.19 mm vs 0.80 +/- 0.23 mm, respectively (results are presented as mean +/- standard deviation).
  
  
  CONCLUSIONS
  Small-scale, single-arm study.
  
  
  CONCLUSIONS
  Our data suggest that LBS without EST is safe and effective in patients with large bile duct stones.
authors: Department of Internal Medicine, Inha University College of Medicine, Incheon, South Korea.
authors: Seok
authors: S
authors: Jeong
authors: Sung-Ho
authors: SH
authors: Ki
authors: Don Haeng
authors: DH
authors: Lee
authors: Jung Il
authors: JI
authors: Lee
authors: Jin-Woo
authors: JW
authors: Lee
authors: Kye Sook
authors: KS
authors: Kwon
authors: Hyung Gil
authors: HG
authors: Kim
authors: Yong Woon
authors: YW
authors: Shin
authors: Young Soo
authors: YS
authors: Kim
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002404:Catheterization / Q000379:methods*; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000379:methods*; D042883:Choledocholithiasis / Q000175:diagnosis / Q000628:therapy*; D000075202:Contraindications; D020698:Duodenoscopes; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016717:Sphincterotomy, Endoscopic; D016896:Treatment Outcome