title: Endoscopic papillary large balloon dilation alone without sphincterotomy for the treatment of large common bile duct stones.
abstract: BACKGROUND
  Lethal pancreatitis has been reported after treatment for common bile duct stones using small endoscopic papillary balloon dilation.
  
  
  METHODS
  We retrospectively evaluated the safety and efficacy of using large balloon dilation alone without the use of sphincterotomy for the treatment of large common bile duct stones in Kaohsiung Veterans General Hospital. Success rate of stone clearance, procedure-related adverse events and incidents, frequency of mechanical lithotripsy use, and recurrent stones were recorded.
  
  
  RESULTS
  A total of 247 patients were reviewed in the current study. The mean age of the patients was 71.2 years. Most of them had comorbidities. Mean stone size was 16.4 mm. Among the patients, 132 (53.4%) had an intact gallbladder and 121 (49%) had a juxtapapillary diverticulum. The mean size of dilating balloon used was 13.2 mm. The mean duration of the dilating procedure was 4.7 min. There were 39 (15.8%) patients required the help of mechanical lithotripsy while retrieving the stones. The final success rate of complete retrieval of stones was 92.7%. The rate of pancreatic duct enhancement was 26.7% (66/247). There were 3 (1.2%) adverse events and 6 (2.4%) intra-procedure bleeding incidents. All patients recovered completely after conservative and endoscopic treatment respectively, and no procedure-related mortality was noted. 172 patients had a follow-up duration of more than 6 months and among these, 25 patients had recurrent common bile duct stones. It was significantly correlated to the common bile duct size (p = 0.036)
  
  
  CONCLUSIONS
  Endoscopic papillary large balloon dilation alone is simple, safe, and effective in dealing with large common bile duct stones in relatively aged and debilitated patients.
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, 386 Ta-Chung 1st Road, Kaohsiung 81362, Taiwan.
authors.forename: Hoi-Hung
authors.initials: HH
authors.lastname: Chan
authors.forename: Kwok-Hung
authors.initials: KH
authors.lastname: Lai
authors.forename: Chiun-Ku
authors.initials: CK
authors.lastname: Lin
authors.forename: Wei-Lun
authors.initials: WL
authors.lastname: Tsai
authors.forename: E-Ming
authors.initials: EM
authors.lastname: Wang
authors.forename: Ping-I
authors.initials: PI
authors.lastname: Hsu
authors.forename: Wen-Chi
authors.initials: WC
authors.lastname: Chen
authors.forename: Hsien-Chung
authors.initials: HC
authors.lastname: Yu
authors.forename: Huay-Min
authors.initials: HM
authors.lastname: Wang
authors.forename: Feng-Woei
authors.initials: FW
authors.lastname: Tsay
authors.forename: Cheng-Chung
authors.initials: CC
authors.lastname: Tsai
authors.forename: I-Shu
authors.initials: IS
authors.lastname: Chen
authors.forename: Yu-Chia
authors.initials: YC
authors.lastname: Chen
authors.forename: Huei-Lung
authors.initials: HL
authors.lastname: Liang
authors.forename: Huay-Ben
authors.initials: HB
authors.lastname: Pan
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002404:Catheterization / Q000009:adverse effects / Q000379:methods*; D016145:Endoscopy, Digestive System; D005260:Female; D005500:Follow-Up Studies; D042882:Gallstones / Q000473:pathology / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012189:Retrospective Studies; D016717:Sphincterotomy, Endoscopic / Q000009:adverse effects; D016896:Treatment Outcome; D055815:Young Adult