title: Short- and long-term outcomes of endoscopic papillary large balloon dilation with or without sphincterotomy for removal of large bile duct stones.
abstract: OBJECTIVE
  Removal of large bile duct stones by endoscopic papillary large balloon dilation (EPLBD) with endoscopic sphincterotomy (EST) has been proven safe and effective. Little evidence supports the benefits of a preceding EST in reducing complications. Recent studies suggest that large bile duct stone removal by EPLBD alone may be safe and effective.
  
  
  METHODS
  We removed large bile duct stones by EPLBD with EST from March 2008 to February 2010 and without EST from March 2010 to October 2011. Efficacy and safety of EPLBD with or without EST and late biliary complication outcomes were assessed.
  
  
  RESULTS
  Forty-two patients (men/women, 27/15; mean age, 76 years) underwent EPLBD: 14 underwent EPLBD with EST and 28 underwent EPLBD without EST. The mean stone size was 14 mm (9-30 mm). Overall complete stone removal rate was 98%, with 83% achieved in 1 session. Complete duct clearance by EPLBD alone was achieved in 79%. Mechanical lithotripsy was required in 4 (10%) patients. Extracorporeal shock wave lithotripsy and electrohydraulic lithotripsy were required in 4 (10%) and 1 (2%) patients, respectively. Pancreatitis and perforation occurred in 2 (5%) and 1 (2%) patients, respectively. Patients treated by EPLBD with EST and by EPLBD alone did not differ in complication outcomes. Six (14%) patients had recurrent bile duct stones, with a significant correlation to dilated common bile duct (p = 0.0351).
  
  
  CONCLUSIONS
  EPLBD is safe and effective in patients with large bile duct stones. Preceding EST may be unnecessary.
authors.affiliation: Department of Endoscopy and Endoscopic Surgery, Graduate School of Medicine, The University of Tokyo , Tokyo , Japan.
authors.forename: Hirofumi
authors.initials: H
authors.lastname: Kogure
authors.forename: Takeshi
authors.initials: T
authors.lastname: Tsujino
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Isayama
authors.forename: Naminatsu
authors.initials: N
authors.lastname: Takahara
authors.forename: Rie
authors.initials: R
authors.lastname: Uchino
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Hamada
authors.forename: Koji
authors.initials: K
authors.lastname: Miyabayashi
authors.forename: Suguru
authors.initials: S
authors.lastname: Mizuno
authors.forename: Dai
authors.initials: D
authors.lastname: Mohri
authors.forename: Yoko
authors.initials: Y
authors.lastname: Yashima
authors.forename: Kazumichi
authors.initials: K
authors.lastname: Kawakubo
authors.forename: Takashi
authors.initials: T
authors.lastname: Sasaki
authors.forename: Natsuyo
authors.initials: N
authors.lastname: Yamamoto
authors.forename: Yousuke
authors.initials: Y
authors.lastname: Nakai
authors.forename: Kenji
authors.initials: K
authors.lastname: Hirano
authors.forename: Naoki
authors.initials: N
authors.lastname: Sasahira
authors.forename: Minoru
authors.initials: M
authors.lastname: Tada
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Koike
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D014670:Ampulla of Vater / Q000601:surgery; D002404:Catheterization / Q000009:adverse effects*; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects*; D004106:Dilatation / Q000009:adverse effects; D005260:Female; D042882:Gallstones / Q000473:pathology / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010195:Pancreatitis / Q000209:etiology; D011446:Prospective Studies; D012008:Recurrence; D016717:Sphincterotomy, Endoscopic / Q000009:adverse effects*; D013997:Time Factors; D016896:Treatment Outcome