title: Limited endoscopic sphincterotomy plus large balloon dilation for choledocholithiasis with periampullary diverticula.
abstract: OBJECTIVE
  To investigate the effectiveness and safety of limited endoscopic sphincterotomy (EST) plus large balloon dilation (LBD) for removing choledocholithiasis in patients with periampullary diverticula (PAD).
  
  
  METHODS
  A total of 139 patients with common bile duct (CBD) stones were treated with LBD (10-20 mm balloon diameter) after limited EST. Of this total, 73 patients had PAD and 66 patients did not have PAD (controls). The results of stone removal and complications were retrospectively evaluated.
  
  
  RESULTS
  There were no significant differences between the PAD and the control groups in overall successful stone removal (94.5% vs 93.9%), stone removal in first session (69.9% vs 81.8%), mechanical lithotripsy (12.3% vs 13.6%), and complications (11.0% vs 7.6%). Clinical outcomes were also similar between the types of PAD, but the rate of stone removal in first session and the number of sessions were significantly lower and more frequent, respectively, in type B PAD (papilla located near the diverticulum) than controls [23/38 (60.5%) vs 54/66 (81.8%), P = 0.021; and 1 (1-2) vs 1 (1-3), P = 0.037, respectively] and the frequency of pancreatitis was significantly higher in type A PAD (papilla located inside or in the margin of the diverticulum) than in controls (16.1% vs 3.0%, P = 0.047).
  
  
  CONCLUSIONS
  Limited EST plus LBD was an effective and safe procedure for removing choledocholithiasis in patients with PAD. However, some types of PAD should be managed with caution.
authors.affiliation: Department of Internal Medicine, Pusan National University School of Medicine and Medical Research Institute, Pusan National University Yangsan Hospital, Beomeo-ri, Mulgeum-eup,Yangsan-si, Gyeongsangnam-do 626-770, South Korea.
authors.forename: Hyung Wook
authors.initials: HW
authors.lastname: Kim
authors.forename: Dae Hwan
authors.initials: DH
authors.lastname: Kang
authors.forename: Cheol Woong
authors.initials: CW
authors.lastname: Choi
authors.forename: Jong Hwan
authors.initials: JH
authors.lastname: Park
authors.forename: Jin Ho
authors.initials: JH
authors.lastname: Lee
authors.forename: Min Dae
authors.initials: MD
authors.lastname: Kim
authors.forename: Il Doo
authors.initials: ID
authors.lastname: Kim
authors.forename: Ki Tae
authors.initials: KT
authors.lastname: Yoon
authors.forename: Mong
authors.initials: M
authors.lastname: Cho
authors.forename: Ung Bae
authors.initials: UB
authors.lastname: Jeon
authors.forename: Suk
authors.initials: S
authors.lastname: Kim
authors.forename: Chang Won
authors.initials: CW
authors.lastname: Kim
authors.forename: Jun Woo
authors.initials: JW
authors.lastname: Lee
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014670:Ampulla of Vater; D002404:Catheterization / Q000379:methods*; D042883:Choledocholithiasis / Q000628:therapy*; D004240:Diverticulum / Q000601:surgery*; D004378:Duodenal Diseases / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016717:Sphincterotomy, Endoscopic / Q000379:methods*
references.citation: Gastrointest Endosc. 2007 Oct;66(4):720-6; quiz 768, 771
references.pmid: 17905013
references.citation: Ann R Coll Surg Engl. 1998 Sep;80(5):326-31
references.pmid: 9849331
references.citation: Surg Laparosc Endosc Percutan Tech. 2006 Aug;16(4):208-11
references.pmid: 16921297
references.citation: Hepatogastroenterology. 2003 May-Jun;50(51):625-8
references.pmid: 12828047
references.citation: Curr Treat Options Gastroenterol. 2006 Apr;9(2):123-32
references.pmid: 16539873
references.citation: Endoscopy. 2008 Mar;40(3):209-13
references.pmid: 18264886
references.citation: Gastrointest Endosc. 2003 May;57(6):633-8
references.pmid: 12709688
references.citation: Gastrointest Endosc. 2008 Jun;67(7):1046-52
references.pmid: 18178208
references.citation: Gastroenterology. 2004 Nov;127(5):1291-9
references.pmid: 15520997
references.citation: Gut. 1989 Jul;30(7):939-42
references.pmid: 2503431
references.citation: Endoscopy. 2003 Aug;35(8):S31-4
references.pmid: 12929051
references.citation: Gastrointest Endosc. 2001 Jul;54(1):56-61
references.pmid: 11427842
references.citation: Surgery. 1990 Feb;107(2):163-6
references.pmid: 2099745
references.citation: Endoscopy. 2004 Dec;36(12):1050-3
references.pmid: 15578293
references.citation: Gastrointest Endosc. 2008 Nov;68(5):903-10
references.pmid: 18635174
references.citation: Endoscopy. 1983 May;15 Suppl 1:197-8
references.pmid: 6872989
references.citation: Gastrointest Endosc. 1991 May-Jun;37(3):383-93
references.pmid: 2070995
references.citation: N Engl J Med. 1996 Sep 26;335(13):909-18
references.pmid: 8782497
references.citation: Gastrointest Endosc. 2003 Feb;57(2):156-9
references.pmid: 12556775
references.citation: Br J Surg. 1999 May;86(5):588-97
references.pmid: 10361174
references.citation: Gastrointest Endosc. 1987 Aug;33(4):298-300
references.pmid: 3115861