Small sphincterotomy combined with endoscopic papillary large balloon dilation versus sphincterotomy.
OBJECTIVE
To compare small sphincterotomy combined with endoscopic papillary large balloon dilation (SES + ELBD) and endoscopic sphincterotomy (EST) for large bile duct stones.


METHODS
We compared prospectively SES + ELBD (group A, n = 27) with conventional EST (group B, n = 28) for the treatment of large bile duct stones (> or = 15 mm). When the stone could not be removed with a normal basket, mechanical lithotripsy was performed. We compared the rates of complete stone removal with one session and application of mechanical lithotripsy.


RESULTS
No significant differences were observed in the mean largest stone size (A: 20.8 mm, B: 21.3 mm), bile duct diameter (A: 21.4 mm, B: 20.5 mm), number of stones (A: 2.2, B: 2.3), or procedure time (A: 18 min, B: 19 min) between the two groups. The rates of complete stone removal with one session was 85% in group A and 86% in group B (P = 0.473). Mechanical lithotripsy was required for stone removal in nine of 27 patients (33%) in group A and nine of 28 patients (32%, P = 0.527) in group B.


CONCLUSIONS
SES + ELBD did not show significant benefits compared to conventional EST, especially for the removal of large (> or = 15 mm) bile duct stones.
Kim
Hyun Gun
HG
Institute for Digestive Research, Department of Internal Medicine, College of Medicine, Soonchunhyang University, 657 Hannam-Dong, Yongsan-Gu, Seoul 140-743, South Korea.
Cheon
Young Koog
YK
Cho
Young Deok
YD
Moon
Jong Ho
JH
Park
Do Hyun
DH
Lee
Tae Hoon
TH
Choi
Hyun Jong
HJ
Park
Sang-Heum
SH
Lee
Joon Seong
JS
Lee
Moon Sung
MS
D000368:Aged; D002404:Catheterization / Q000009:adverse effects / Q000379:methods*; D042883:Choledocholithiasis / Q000473:pathology / Q000601:surgery*; D003131:Combined Modality Therapy; D003135:Common Bile Duct / Q000473:pathology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016717:Sphincterotomy, Endoscopic / Q000009:adverse effects / Q000379:methods*; D016896:Treatment Outcome