title: Endoscopic papillary large-balloon dilation following limited sphincterotomy for the removal of refractory bile duct stones: experience of 169 cases in a single Chinese center.
abstract: OBJECTIVE
  To evaluate the efficacy and safety of endoscopic papillary large-balloon dilation (EPLBD) combined with limited endoscopic sphincterotomy (EST) for the removal of large biliary duct stones (≥10 mm).
  
  
  METHODS
  Data of patients who underwent an attempted removal of large bile duct stones by limited EST followed by EPLBD (≥12 mm in diameter) from April 2006 to October 2011 in our center were reviewed. Clinical characteristics, endoscopic methods and outcomes of the patients were collected and analyzed.
  
  
  RESULTS
  A total of 169 patients with a mean age of 69.3 years (range 19-97 years) underwent 171 procedures. Median stone size and balloon diameter was 15 mm and 13 mm, respectively. Complete stone removal in a single session was achieved in 163 procedures (95.3%) with mechanical lithotripsy (ML) used in 66 (38.6%). Patients with a larger stone size required more frequent use of ML with a comparable success rate (P < 0.01). There were no significant differences between patients with and without periampullary diverticula in stone clearance (97.3% vs 93.8%), ML requirement (36.5% vs 40.2%) and complications (2.7% vs 6.2%) (all P > 0.05). Seven patients had eight procedure-related complications including moderate or mild bleeding (n = 4), minor perforation (n = 1), mild pancreatitis (n = 2) and cholangitis (n = 1).
  
  
  CONCLUSIONS
  EPLBD following limited EST is an effective and safe approach for the removal of large biliary duct stones, especially for those refractory cases.
authors.affiliation: Department of Endoscopy, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China.
authors.forename: Xiao Ming
authors.initials: XM
authors.lastname: Yang
authors.forename: Bing
authors.initials: B
authors.lastname: Hu
authors.forename: Ya Min
authors.initials: YM
authors.lastname: Pan
authors.forename: Dao Jian
authors.initials: DJ
authors.lastname: Gao
authors.forename: Tian Tian
authors.initials: TT
authors.lastname: Wang
authors.forename: Jun
authors.initials: J
authors.lastname: Wu
authors.forename: Xin
authors.initials: X
authors.lastname: Ye
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002760:Cholangiopancreatography, Endoscopic Retrograde; D004106:Dilatation / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D005260:Female; D042882:Gallstones / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008096:Lithotripsy; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D016717:Sphincterotomy, Endoscopic / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D015607:Stents; D016896:Treatment Outcome; D055815:Young Adult