title: Endoscopic papillary balloon dilation for bile duct stone removal in patients 60 years old or younger.
abstract: BACKGROUND
  The aim of this study was to evaluate short- and long-term outcomes in relatively young patients (≤ 60 years old) who underwent endoscopic papillary balloon dilation (EPBD) for bile duct stone removal.
  
  
  METHODS
  Immediate and long-term outcomes were evaluated in 311 patients who were 60 years old or younger at the time of EPBD. The stone recurrence rate was compared among four groups stratified according to gallbladder (GB) status before and after EPBD (cholecystectomy after EPBD, GB left in situ with stones, GB left in situ without stones, and cholecystectomy before EPBD).
  
  
  RESULTS
  Bile duct stones were completely removed via EPBD alone in 304 patients (97.7%). Post-EPBD pancreatitis occurred in 24 patients (7.7%), and was mild in 18 patients, moderate in 5 patients, and severe in 1 patient. The rate of pancreatitis was significantly higher in these patients than in patients aged more than 60 years who underwent EPBD during the same study period (4.7%). Long-term outcomes were evaluated in 217 patients who were followed for at least 1 year after complete stone removal via EPBD. During a mean follow-up period of 5.6 years (range, 1.0-13.4 years), stone recurrence was observed in 13 patients (6.0%). The cumulative stone recurrence rates at 5 and 10 years after EPBD were 5.9 and 7.1%, respectively. Patients in the cholecystectomy after EPBD group had the lowest risk of stone recurrence among the four groups (2.0%).
  
  
  CONCLUSIONS
  EPBD removes bile duct stones in the majority of younger patients without increasing the risk of severe pancreatitis. Post-EPBD pancreatitis is more likely to occur in younger patients as compared to older patients. The long-term outcomes of EPBD appear favorable, especially in patients who have undergone cholecystectomy after EPBD.
authors.affiliation: Department of Gastroenterology, Faculty of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, Japan. tsujinot-int@h.u-tokyo.ac.jp
authors.forename: Takeshi
authors.initials: T
authors.lastname: Tsujino
authors.forename: Haruhiko
authors.initials: H
authors.lastname: Yoshida
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Isayama
authors.forename: Yukiko
authors.initials: Y
authors.lastname: Ito
authors.forename: Yoko
authors.initials: Y
authors.lastname: Yashima
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Yagioka
authors.forename: Hirofumi
authors.initials: H
authors.lastname: Kogure
authors.forename: Takashi
authors.initials: T
authors.lastname: Sasaki
authors.forename: Toshihiko
authors.initials: T
authors.lastname: Arizumi
authors.forename: Osamu
authors.initials: O
authors.lastname: Togawa
authors.forename: Saburo
authors.initials: S
authors.lastname: Matsubara
authors.forename: Yousuke
authors.initials: Y
authors.lastname: Nakai
authors.forename: Naoki
authors.initials: N
authors.lastname: Sasahira
authors.forename: Kenji
authors.initials: K
authors.lastname: Hirano
authors.forename: Minoru
authors.initials: M
authors.lastname: Tada
authors.forename: Takao
authors.initials: T
authors.lastname: Kawabe
authors.forename: Masao
authors.initials: M
authors.lastname: Omata
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Koike
mesh_terms: D000328:Adult; D000367:Age Factors; D002404:Catheterization / Q000009:adverse effects / Q000379:methods*; D002763:Cholecystectomy / Q000009:adverse effects / Q000379:methods; D016145:Endoscopy, Digestive System / Q000009:adverse effects / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D042882:Gallstones / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010195:Pancreatitis / Q000453:epidemiology / Q000209:etiology*; D012008:Recurrence; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
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