title: Endoscopic large-balloon dilation alone versus endoscopic sphincterotomy plus large-balloon dilation for the treatment of large bile duct stones.
abstract: BACKGROUND
  Endoscopic sphincterotomy (EST) combined with large-balloon dilation (LBD) has been proposed as an alternative to manage large bile duct stones. However, recent reports indicate that LBD without EST may be safe and effective in this setting.
  
  
  METHODS
  One hundred thirty-one patients with large common bile duct (CBD) stones 12 mm in size or larger underwent LBD alone (n=62) or EST plus LBD (n=69) for lithotripsy. The therapeutic outcome and complications were reviewed and compared.
  
  
  RESULTS
  There were no differences between the two groups with regard to age, size and number of stones, or bile duct diameter. The LBD alone group (mean age, 70.4 years) and the EST plus LBD group (mean age, 68.2 years) had similar outcomes in terms of overall successful stone removal (96.8% vs. 95.7%, P=0.738) and complete stone removal without the need for mechanical lithotripsy (80.6% vs. 73.9%, P=0.360). Complications in the LBD alone and EST plus LBD groups were as follows: pancreatitis (6.5% vs. 4.3%, P=0.593), impaction of basket and stone (0% vs. 1.4%, P=0.341), and perforation (0% vs. 1.4%, P=0.341).
  
  
  CONCLUSIONS
  LBD alone may be a simple, safe, and effective alternative to EST plus LBD in relatively aged patients with large CBD stones, and it can simplify the procedure compared with EST plus LBD.
authors: Department of Gastroenterology, Ajou University School of Medicine, San-5, Woncheon-dong, Yongtong-gu 443-721 Suwon, Korea.
authors: Jae Chul
authors: JC
authors: Hwang
authors: Jin Hong
authors: JH
authors: Kim
authors: Sun Gyo
authors: SG
authors: Lim
authors: Soon Sun
authors: SS
authors: Kim
authors: Sung Jae
authors: SJ
authors: Shin
authors: Kee Myung
authors: KM
authors: Lee
authors: Byung Moo
authors: BM
authors: Yoo
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002760:Cholangiopancreatography, Endoscopic Retrograde; D003131:Combined Modality Therapy; D004106:Dilatation / Q000379:methods*; D016145:Endoscopy, Digestive System / Q000379:methods*; D005260:Female; D042882:Gallstones / Q000628:therapy*; D015905:Gastric Balloon; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D016717:Sphincterotomy, Endoscopic / Q000379:methods*; D016896:Treatment Outcome