Endoscopic papillary balloon dilation for bile duct stone removal in patients 60 years old or younger.
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.
Tsujino
Takeshi
T
Department of Gastroenterology, Faculty of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, Japan. tsujinot-int@h.u-tokyo.ac.jp
Yoshida
Haruhiko
H
Isayama
Hiroyuki
H
Ito
Yukiko
Y
Yashima
Yoko
Y
Yagioka
Hiroshi
H
Kogure
Hirofumi
H
Sasaki
Takashi
T
Arizumi
Toshihiko
T
Togawa
Osamu
O
Matsubara
Saburo
S
Nakai
Yousuke
Y
Sasahira
Naoki
N
Hirano
Kenji
K
Tada
Minoru
M
Kawabe
Takao
T
Omata
Masao
M
Koike
Kazuhiko
K
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
Endoscopy. 1998 Jan;30(1):43-5
9548044
Gastrointest Endosc. 1997 May;45(5):400-5
9165322
Gastrointest Endosc. 1993 Nov-Dec;39(6):749-54
8293895
J Gastroenterol Hepatol. 1999 Jan;14(1):90-6
10029284
Gastrointest Endosc. 2004 Aug;60(2):186-90
15278042
Br J Surg. 1998 Jul;85(7):917-21
9692563
Gastrointest Endosc. 2003 Feb;57(2):151-5
12556774
Gastroenterology. 1990 Apr;98(4):1008-12
2311858
Gastrointest Endosc. 2008 Jun;67(7):1046-52
18178208
Gastrointest Endosc. 1996 Dec;44(6):643-9
8979051
Gastrointest Endosc. 1995 Nov;42(5):468-74
8566640
Clin Gastroenterol Hepatol. 2008 Sep;6(9):1049-53
18585972
Endoscopy. 1988 Aug;20 Suppl 1:207-10
3168949
Nat Clin Pract Gastroenterol Hepatol. 2005 Feb;2(2):74-5
16265121
Gastrointest Endosc. 2007 Oct;66(4):720-6; quiz 768, 771
17905013
Hepatogastroenterology. 2003 Nov-Dec;50(54):1787-91
14696405
Clin Gastroenterol Hepatol. 2007 Jan;5(1):130-7
17234559
Surg Endosc. 2007 Jan;21(1):34-40
17111284
Endoscopy. 1998 Jun;30(5):457-63
9693893
Lancet. 1997 Apr 19;349(9059):1124-9
9113010
Hepatogastroenterology. 2003 Jul-Aug;50(52):919-23
12845950
Am J Gastroenterol. 2002 Nov;97(11):2763-7
12425545
Gastroenterology. 1996 Mar;110(3):894-9
8608900
J Gastroenterol Hepatol. 2008 Jun;23(6):867-71
18086110
Surgery. 1997 May;121(5):488-92
9142145
Ann Surg. 1989 May;209(5):584-91; discussion 591-2
2705823
Gastrointest Endosc. 1991 May-Jun;37(3):383-93
2070995
N Engl J Med. 1996 Sep 26;335(13):909-18
8782497
Gut. 2001 Nov;49(5):686-91
11600473
Am J Gastroenterol. 2004 Aug;99(8):1455-60
15307859
Gastrointest Endosc. 1998 Nov;48(5):465-9
9831833
Gastroenterology. 2004 Nov;127(5):1291-9
15520997
Gastrointest Endosc. 2008 Sep;68(3):477-82
18760175
Am J Gastroenterol. 2006 Jan;101(1):139-47
16405547