title: Comparison of the usefulness of endoscopic papillary large-balloon dilation with endoscopic sphincterotomy for large and multiple common bile duct stones.
abstract: BACKGROUND
  Endoscopic sphincterotomy (EST) is currently recognized as the primary endoscopic treatment for common bile duct stones. However, it is difficult to remove multiple (≥ 3) or large (≥ 15 mm) common bile duct stones with EST alone. Recently, EST plus endoscopic papillary large-balloon dilation (EPLBD) was reported to be an effective treatment for such bile duct stones. We compared the results of EST and EST + EPLBD for multiple (≥ 3) or large (≥ 15 mm) stones that were difficult to treat using EST alone. We also compared the complication rates between the techniques.
  
  
  METHODS
  Seventy patients with large (largest diameter, ≥ 15 mm) or ≥ 3 common bile duct stones treated in our department between April 2010 and March 2013 underwent EST + EPLBD (n = 34) or EST alone (n = 36). We compared final successful stone removal rates, rates of successful stone removal in the first session, procedure times, status of concurrent mechanical lithotripsy (ML), and complications between the EST + EPLBD and EST groups.
  
  
  RESULTS
  The rates of final successful stone removal were similar between the two groups (EST + EPLBD: 100 % vs. EST: 89 %; p = 0.115). The rate of successful stone removal in the first session was significantly higher in the EST + EPLBD group (EST + EPLBD: 88 % vs. EST: 56 %; p = 0.03). Moreover, the procedure time was significantly shorter (EST + EPLBD: 42 min vs. EST: 67 min; p = 0.011) and the rate of ML use was significantly lower in the EST + EPLBD group (EST + EPLBD: 50 % vs. EST: 94 %; p < 0.001). Complications like pancreatitis and bleeding occurred in three patients in the EST + EPLBD group and in 10 patients in the EST group, but the differences were not statistically significant (EST + EPLBD: 9 % vs. EST: 25 %; p = 0.112).
  
  
  CONCLUSIONS
  Our results suggest that EST + EPLBD is an effective therapy for patients with difficult-to-treat multiple or large common bile duct stones, because it requires fewer sessions and shorter operative times than EST alone.
authors.affiliation: Department of Gastroenterology, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Shimotsuga, Tochigi, 321-0293, Japan. tsuchida@dokkyomed.ac.jp.
authors.forename: Kouhei
authors.initials: K
authors.lastname: Tsuchida
authors.affiliation: Department of Gastroenterology, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Shimotsuga, Tochigi, 321-0293, Japan. m.kizuki.1014@gmail.com.
authors.forename: Mari
authors.initials: M
authors.lastname: Iwasaki
authors.affiliation: Department of Gastroenterology, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Shimotsuga, Tochigi, 321-0293, Japan. b_cosan@yahoo.co.jp.
authors.forename: Misako
authors.initials: M
authors.lastname: Tsubouchi
authors.affiliation: Department of Gastroenterology, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Shimotsuga, Tochigi, 321-0293, Japan. httptsunehirocom@yahoo.co.jp.
authors.forename: Tsunehiro
authors.initials: T
authors.lastname: Suzuki
authors.affiliation: Department of Gastroenterology, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Shimotsuga, Tochigi, 321-0293, Japan. cyamaura@dokkyomed.ac.jp.
authors.forename: Chieko
authors.initials: C
authors.lastname: Tsuchida
authors.affiliation: Department of Gastroenterology, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Shimotsuga, Tochigi, 321-0293, Japan. naoto-y@dokkyomed.ac.jp.
authors.forename: Naoto
authors.initials: N
authors.lastname: Yoshitake
authors.affiliation: Department of Gastroenterology, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Shimotsuga, Tochigi, 321-0293, Japan. tksasai@dokkyomed.ac.jp.
authors.forename: Takako
authors.initials: T
authors.lastname: Sasai
authors.affiliation: Department of Gastroenterology, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Shimotsuga, Tochigi, 321-0293, Japan. hiraishi@dokkyomed.ac.jp.
authors.forename: Hideyuki
authors.initials: H
authors.lastname: Hiraishi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000379:methods*; D042883:Choledocholithiasis / Q000628:therapy*; D003131:Combined Modality Therapy; D004106:Dilatation / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology; D016717:Sphincterotomy, Endoscopic; D016896:Treatment Outcome