Limited endoscopic sphincterotomy plus large balloon dilation for choledocholithiasis with periampullary diverticula.
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.
Kim
Hyung Wook
HW
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.
Kang
Dae Hwan
DH
Choi
Cheol Woong
CW
Park
Jong Hwan
JH
Lee
Jin Ho
JH
Kim
Min Dae
MD
Kim
Il Doo
ID
Yoon
Ki Tae
KT
Cho
Mong
M
Jeon
Ung Bae
UB
Kim
Suk
S
Kim
Chang Won
CW
Lee
Jun Woo
JW
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*
Gastrointest Endosc. 2007 Oct;66(4):720-6; quiz 768, 771
17905013
Ann R Coll Surg Engl. 1998 Sep;80(5):326-31
9849331
Surg Laparosc Endosc Percutan Tech. 2006 Aug;16(4):208-11
16921297
Hepatogastroenterology. 2003 May-Jun;50(51):625-8
12828047
Curr Treat Options Gastroenterol. 2006 Apr;9(2):123-32
16539873
Endoscopy. 2008 Mar;40(3):209-13
18264886
Gastrointest Endosc. 2003 May;57(6):633-8
12709688
Gastrointest Endosc. 2008 Jun;67(7):1046-52
18178208
Gastroenterology. 2004 Nov;127(5):1291-9
15520997
Gut. 1989 Jul;30(7):939-42
2503431
Endoscopy. 2003 Aug;35(8):S31-4
12929051
Gastrointest Endosc. 2001 Jul;54(1):56-61
11427842
Surgery. 1990 Feb;107(2):163-6
2099745
Endoscopy. 2004 Dec;36(12):1050-3
15578293
Gastrointest Endosc. 2008 Nov;68(5):903-10
18635174
Endoscopy. 1983 May;15 Suppl 1:197-8
6872989
Gastrointest Endosc. 1991 May-Jun;37(3):383-93
2070995
N Engl J Med. 1996 Sep 26;335(13):909-18
8782497
Gastrointest Endosc. 2003 Feb;57(2):156-9
12556775
Br J Surg. 1999 May;86(5):588-97
10361174
Gastrointest Endosc. 1987 Aug;33(4):298-300
3115861