title: Superiority of 10-mm-wide balloon over 8-mm-wide balloon in papillary dilation for bile duct stones: A matched cohort study.
abstract: OBJECTIVE
  Endoscopic papillary balloon dilation (EPBD) is a possible alternative to endoscopic sphincterotomy (EST) for common bile duct (CBD) stones. To date, 10- and 8-mm EPBD have not been fully compared.
  
  
  METHODS
  Patients who underwent EPBD for CBD stones at two Japanese tertiary care centers between May 1994 and January 2014 were identified. Matched pairs with 10- and 8-mm EPBD were generated. Short- and long-term outcomes were compared between the two groups.
  
  
  RESULTS
  A total of 869 patients were identified (61 and 808 patients for 10- and 8-mm EPBD, respectively), and 61 well-balanced pairs were generated. The rate of complete stone removal within a single session was higher in the 10-mm EPBD group than in the 8-mm EPBD group (69% vs. 44%, P < 0.001), and use of lithotripsy was less frequent in the 10-mm EPBD group (23% vs. 56%, P < 0.001). The rates of post-ERCP pancreatitis were similar between the 10- and 8-mm EPBD groups (11% vs. 8%). Cumulative biliary complication-free rates were not statistically different between the two groups: 88% [95% confidence interval (CI): 79-97%] and 94% (95% CI: 88-100%) at 1 year and 69% (95% CI: 56-85%) and 80% (95% CI: 69-93%) at 2 years in the 10- and 8-mm EPBD groups, respectively. In the 10-mm EPBD group, ascending cholangitis was not observed, and pneumobilia was found in 5% of cases during the follow-up period.
  
  
  CONCLUSIONS
  EPBD using a 10-mm balloon for CBD stones is safe and more effective than 8-mm EPBD. The sphincter function is highly preserved after 10-mm EPBD.
authors.forename: Dai
authors.initials: D
authors.lastname: Akiyama
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Hamada
authors.affiliation: Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Isayama
authors.forename: Yousuke
authors.initials: Y
authors.lastname: Nakai
authors.forename: Takeshi
authors.initials: T
authors.lastname: Tsujino
authors.forename: Gyotane
authors.initials: G
authors.lastname: Umefune
authors.forename: Naminatsu
authors.initials: N
authors.lastname: Takahara
authors.forename: Dai
authors.initials: D
authors.lastname: Mohri
authors.forename: Hirofumi
authors.initials: H
authors.lastname: Kogure
authors.forename: Saburo
authors.initials: S
authors.lastname: Matsubara
authors.forename: Yukiko
authors.initials: Y
authors.lastname: Ito
authors.forename: Natsuyo
authors.initials: N
authors.lastname: Yamamoto
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; D002404:Catheterization / Q000295:instrumentation*; D002760:Cholangiopancreatography, Endoscopic Retrograde; D015331:Cohort Studies; D004106:Dilatation / Q000295:instrumentation*; D005260:Female; D042882:Gallstones / Q000601:surgery*; D006801:Humans; D008297:Male; D013997:Time Factors; D016896:Treatment Outcome