Long-term recurrence of bile duct stones after endoscopic papillary large balloon dilation with sphincterotomy: 4-year extended follow-up of a randomized trial.
Endoscopic papillary large balloon dilation with biliary sphincterotomy (EPLBD + EBS) is safe and effective in patients with large common bile duct (CBD) stones. However, data on long-term outcomes after EPLBD + EBS remain limited. We sought to prospectively evaluate the long-term recurrence of CBD stones after EPLBD + EBS and to identify the associated factors.



We conducted an extended follow-up of a previous randomized trial (2009-2011) comparing the outcomes of 30- versus 60-s large balloon dilation. A total of 106 trial participants undergoing successful CBD stone clearance by EPLBD + EBS were prospectively followed up for up to 4 years (range 19-48 months). Various risk factors were analysed to assess predictors of long-term recurrence of stones.



Recurrent CBD stones appeared in 8/106 (7.5 %) patients during a mean follow-up of 30.5 ± 5.5 months. The mean diameter of CBD was significantly higher in the recurrence versus non-recurrence group (2.0 ± 4.9 vs 1.6 ± 0.9 cm, p = 0.008). Multivariate analysis revealed that CBD diameter was the only predictor significantly associated with the long-term recurrence of stones (odds ratio 1.2, p = 0.01).



EPLBD + EBS is associated with a low rate of long-term CBD stone recurrence. However, the risk is significantly higher in patients with a more dilated CBD.
Department of Gastroenterology, Benizelion General Hospital, L.Knossou, 71409, Heraklion, Crete, Greece. gpaspatis@gmail.com.
Gregorios A
GA
Paspatis
Konstantopoulio General Hospital, Athens, Greece.
Konstantina
K
Paraskeva
Department of Gastroenterology, Benizelion General Hospital, L.Knossou, 71409, Heraklion, Crete, Greece.
Emmanouil
E
Vardas
Konstantopoulio General Hospital, Athens, Greece.
Vasilios
V
Papastergiou
Department of Gastroenterology, Benizelion General Hospital, L.Knossou, 71409, Heraklion, Crete, Greece.
Aikaterini
A
Tavernaraki
Department of Gastroenterology, Benizelion General Hospital, L.Knossou, 71409, Heraklion, Crete, Greece.
Maria
M
Fragaki
Department of Gastroenterology, Benizelion General Hospital, L.Knossou, 71409, Heraklion, Crete, Greece.
Angeliki
A
Theodoropoulou
Department of Social Medicine, University of Crete, Heraklion, Greece.
Gregorios
G
Chlouverakis
D000368:Aged; D000369:Aged, 80 and over; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000379:methods*; D042883:Choledocholithiasis / Q000601:surgery*; D003135:Common Bile Duct / Q000473:pathology*; D004106:Dilatation / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009929:Organ Size; D016032:Randomized Controlled Trials as Topic; D012008:Recurrence; D012307:Risk Factors; D016717:Sphincterotomy, Endoscopic / Q000379:methods*
Endoscopic retrograde cholangiopancreatography; Large balloon dilation; Sphincterotomy; Stone recurrence