title: Significance of Endoscopic Sphincterotomy Preceding Endoscopic Papillary Large Balloon Dilation in the Management of Bile Duct Stones.
abstract: BACKGROUND
  Endoscopic papillary large balloon dilation (EPLBD) is safe and effective in management of common bile duct stones (CBDS). Endoscopic sphincterotomy (EST) prior to EPLBD has been performed as a standard procedure. However, the significance of EST prior to EPLBD has not been well studied yet.
  
  
  OBJECTIVE
  To compare the clinical outcomes of EPLBD with and without EST to evaluate the significance of EST.
  
  
  METHODS
  Between April 2010 and March 2015, a total of 82 patients with naïve papillae underwent EPLBD with or without EST for the management of CBDS. A retrospective analysis compared the efficacy and safety of EPLBD with and without EST.
  
  
  RESULTS
  Basic patient characteristics were not significantly different between the groups that underwent EPLBD with EST (n = 27) and without EST (n = 55). Complete stone removal rates were similar between the groups (100 % in the EST group and 98 % in the non-EST group, p = 1.00). There was no significant difference in the median balloon size (13 mm in both groups, p = 0.445), rate of application of mechanical lithotripsy (26 vs. 35 % in the EST and non-EST groups, respectively, p = 0.463), or the median procedure time (38 vs. 34 min in the EST and non-EST groups, respectively, p = 0.682). The overall adverse event rates were not statistically different (4 vs. 7 % in the EST and non-EST groups, respectively, p = 1.00). Pancreatitis, cholangitis, and hemorrhage rates were also similar in both groups.
  
  
  CONCLUSIONS
  EST prior to EPLBD may be unnecessary since this study did not demonstrate its benefits.
authors.affiliation: First Department of Internal Medicine, Gifu University Hospital, 1-1 Yanagido, Gifu, 501-1194, Japan.
authors.forename: Mitsuru
authors.initials: M
authors.lastname: Okuno
authors.affiliation: First Department of Internal Medicine, Gifu University Hospital, 1-1 Yanagido, Gifu, 501-1194, Japan. takuji@w7.dion.ne.jp.
authors.forename: Takuji
authors.initials: T
authors.lastname: Iwashita
authors.affiliation: First Department of Internal Medicine, Gifu University Hospital, 1-1 Yanagido, Gifu, 501-1194, Japan.
authors.forename: Kensaku
authors.initials: K
authors.lastname: Yoshida
authors.affiliation: First Department of Internal Medicine, Gifu University Hospital, 1-1 Yanagido, Gifu, 501-1194, Japan.
authors.forename: Akinori
authors.initials: A
authors.lastname: Maruta
authors.affiliation: First Department of Internal Medicine, Gifu University Hospital, 1-1 Yanagido, Gifu, 501-1194, Japan.
authors.forename: Shinya
authors.initials: S
authors.lastname: Uemura
authors.affiliation: Department of Gastroenterology, Gifu Municipal Hospital, Gifu, Japan.
authors.forename: Masanori
authors.initials: M
authors.lastname: Nakashima
authors.affiliation: Department of Gastroenterology, Gifu Municipal Hospital, Gifu, Japan.
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Mukai
authors.affiliation: Department of Gastroenterology, Gifu Prefectural General Medical Center, Gifu, Japan.
authors.forename: Nobuhiro
authors.initials: N
authors.lastname: Ando
authors.affiliation: Department of Gastroenterology, Gifu Prefectural General Medical Center, Gifu, Japan.
authors.forename: Keisuke
authors.initials: K
authors.lastname: Iwata
authors.affiliation: Department of Gastroenterology, Gihoku Kousei Hospital, Gifu, Japan.
authors.forename: Yohei
authors.initials: Y
authors.lastname: Horibe
authors.affiliation: Department of Gastroenterology, Gihoku Kousei Hospital, Gifu, Japan.
authors.forename: Seiji
authors.initials: S
authors.lastname: Adachi
authors.affiliation: Department of Gastroenterology, Teikyo University Mizonokuchi Hospital, Kawasaki, Japan.
authors.forename: Masatoshi
authors.initials: M
authors.lastname: Mabuchi
authors.affiliation: Department of Gastroenterology, Teikyo University Mizonokuchi Hospital, Kawasaki, Japan.
authors.forename: Shinpei
authors.initials: S
authors.lastname: Doi
authors.affiliation: Department of Gastroenterology, Teikyo University Mizonokuchi Hospital, Kawasaki, Japan.
authors.forename: Ichiro
authors.initials: I
authors.lastname: Yasuda
authors.affiliation: First Department of Internal Medicine, Gifu University Hospital, 1-1 Yanagido, Gifu, 501-1194, Japan.
authors.forename: Masahito
authors.initials: M
authors.lastname: Shimizu
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects / Q000379:methods*; D002769:Cholelithiasis / Q000601:surgery*; D003131:Combined Modality Therapy; D004106:Dilatation / Q000295:instrumentation / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D011183:Postoperative Complications; D012189:Retrospective Studies; D016717:Sphincterotomy, Endoscopic / Q000295:instrumentation / Q000379:methods*; D016896:Treatment Outcome
keywords: Adverse event; Common bile duct stone; Endoscopic papillary large balloon dilation; Endoscopic retrograde cholangiopancreatography; Endoscopic sphincterotomy; Pancreatitis