title: Ampulla dilation with different sized balloons to remove common bile duct stones.
abstract: OBJECTIVE
  To assess the outcomes of ampulla dilation with different sized balloons to remove common bile duct (CBD) stones.
  
  
  METHODS
  Patients (n = 208) were divided into five groups based on the largest CBD stone size of < 5, 6-8, 8-12, 12-14, and > 14 mm. Patients underwent limited endoscopic sphincterotomy (EST) alone or limited EST followed by endoscopic papillary balloon dilation with 8, 10, 12 and 14 mm balloons, such that the size of each balloon did not exceed the size of the CBD. Short- and long-term outcomes, such as post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis, perforation, bleeding, and pneumobilia were compared among the five groups.
  
  
  RESULTS
  The overall rate of successful stone removal in all groups was 100%, and all patients were cured. Eight (3.85%) patients had post-ERCP pancreatitis, none had perforations, and 6 (2.9%) had bleeding requiring transfusion. There were no significant differences in early complication rates among the five groups. We observed significant correlations between increased balloon size and the short- and long-term rates of post-ERCP pneumobilia. Post-ERCP pancreatitis and bleeding correlated significantly with age, with post-ERCP pancreatitis occurring more frequently in patients aged < 60 years, and bleeding occurring more frequently in patients aged > 70 years. We observed a significant correlation between patient age and the diameter of the largest CBD stone, with stones > 12 mm occurring more frequently in patients > 60 years old.
  
  
  CONCLUSIONS
  Choosing a balloon size based on the largest stone diameter is safe and effective for removing CBD stones. Balloon size should not exceed 15 mm.
authors: Department of General Surgery, Shanghai Gongli Hospital, Shanghai 200135, China. linengp@163.com
authors: Neng-Ping
authors: NP
authors: Li
authors: Jiang-Qi
authors: JQ
authors: Liu
authors: Zhi-Qiang
authors: ZQ
authors: Zhou
authors: Tao-Ying
authors: TY
authors: Ji
authors: Xiao-Yan
authors: XY
authors: Cai
authors: Qing-Yun
authors: QY
authors: Zhu
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D014670:Ampulla of Vater / Q000601:surgery*; D000704:Analysis of Variance; D001803:Blood Transfusion; D057785:Catheters; D016009:Chi-Square Distribution; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects / Q000295:instrumentation*; D042883:Choledocholithiasis / Q000175:diagnosis / Q000601:surgery*; D004106:Dilatation / Q000295:instrumentation*; D004867:Equipment Design; D005260:Female; D042882:Gallstones / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010195:Pancreatitis / Q000209:etiology; D018579:Patient Selection; D019106:Postoperative Hemorrhage / Q000209:etiology / Q000628:therapy; D011446:Prospective Studies; D012307:Risk Factors; D016717:Sphincterotomy, Endoscopic; D013997:Time Factors; D016896:Treatment Outcome
keywords: Common bile duct stone; Endoscopic papillary balloon dilation; Endoscopic retrograde cholangiopancreatography; Endoscopic sphincterotomy; Pancreatitis