title: Small sphincterotomy combined with endoscopic papillary large balloon dilation versus sphincterotomy.
abstract: 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.
authors.affiliation: Institute for Digestive Research, Department of Internal Medicine, College of Medicine, Soonchunhyang University, 657 Hannam-Dong, Yongsan-Gu, Seoul 140-743, South Korea.
authors.forename: Hyun Gun
authors.initials: HG
authors.lastname: Kim
authors.forename: Young Koog
authors.initials: YK
authors.lastname: Cheon
authors.forename: Young Deok
authors.initials: YD
authors.lastname: Cho
authors.forename: Jong Ho
authors.initials: JH
authors.lastname: Moon
authors.forename: Do Hyun
authors.initials: DH
authors.lastname: Park
authors.forename: Tae Hoon
authors.initials: TH
authors.lastname: Lee
authors.forename: Hyun Jong
authors.initials: HJ
authors.lastname: Choi
authors.forename: Sang-Heum
authors.initials: SH
authors.lastname: Park
authors.forename: Joon Seong
authors.initials: JS
authors.lastname: Lee
authors.forename: Moon Sung
authors.initials: MS
authors.lastname: Lee
mesh_terms: 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