title: One-step transfistula large versus conventional balloon dilation following precut fistulotomy in difficult biliary cannulation for the removal of biliary stones: a multicenter retrospective study.
abstract: OBJECTIVE
  After selective biliary access following precut fistulotomy in difficult biliary cannulations (DBC), there are several methods of completely opening the remaining papillary roof for the removal of biliary stones. We evaluated the efficacy of one-step transfistula balloon dilation following fistulotomy in DBC for the removal of biliary stones.
  
  
  METHODS
  This retrospective multicenter study was performed in four tertiary referral centers. Patients who underwent fistulotomy due to DBC were enrolled. Precut fistulotomy followed by conventional (≤ 10 mm) or large balloon (≥ 12 mm) dilation through the fistulotomy tract was performed to remove biliary stones. The main outcome measures were technical success and transfistula balloon dilation-related complications.
  
  
  RESULTS
  A total of 154 patients were enrolled. Large balloon and conventional balloon dilation were performed in 57 and 97 patients, respectively. The primary technical success of stone removal was 100% (57/57) for large balloon dilation and 96.9% (94/97) for conventional balloon dilation (P = 0.296). The mean procedure time from biliary access to removal of stones was 29.3 min in large balloon and 22.2 min in conventional balloon dilation (P = 0.042), and the mean numbers of endoscopic retrograde cholangiopancreatography sessions were 1.4 and 1.3, respectively (P = 0.175). Transfistula balloon dilation-related complications were not different between the two groups (10.5% in large balloon dilation vs 16.5% in conventional balloon dilation, P = 0.307).
  
  
  CONCLUSIONS
  One-step transfistula balloon dilation following precut fistulotomy in DBC may be safe and effective for the removal of biliary stones. There were no differences in therapeutic outcomes and complications between large and conventional balloon dilation.
authors.affiliation: Digestive Disease Center, Department of Internal Medicine, Soonchunhyang University School of Medicine, Cheonan and Bucheon, South Korea.
authors.forename: Baek Gyu
authors.initials: BG
authors.lastname: Jun
authors.forename: Tae Hoon
authors.initials: TH
authors.lastname: Lee
authors.forename: Seok
authors.initials: S
authors.lastname: Jeong
authors.forename: Jae Chul
authors.initials: JC
authors.lastname: Hwang
authors.forename: Min Jae
authors.initials: MJ
authors.lastname: Yang
authors.forename: Tae Jun
authors.initials: TJ
authors.lastname: Song
authors.forename: Hyun Jong
authors.initials: HJ
authors.lastname: Choi
authors.forename: Jong Ho
authors.initials: JH
authors.lastname: Moon
authors.forename: Sang-Heum
authors.initials: SH
authors.lastname: Park
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001662:Biliary Tract Surgical Procedures; D002404:Catheterization / Q000379:methods*; D042883:Choledocholithiasis / Q000601:surgery*; D016145:Endoscopy, Digestive System; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: balloon dilation; biliary stone; difficult cannulation; fistulotomy