Endoscopic large-balloon sphincteroplasty without preceding sphincterotomy for the removal of large bile duct stones: a preliminary study.
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.
Jeong
Seok
S
Department of Internal Medicine, Inha University College of Medicine, Incheon, South Korea.
Ki
Sung-Ho
SH
Lee
Don Haeng
DH
Lee
Jung Il
JI
Lee
Jin-Woo
JW
Kwon
Kye Sook
KS
Kim
Hyung Gil
HG
Shin
Yong Woon
YW
Kim
Young Soo
YS
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