title: Limited precut sphincterotomy combined with endoscopic papillary balloon dilation for common bile duct stone removal in patients with difficult biliary cannulation.
abstract: BACKGROUND
  Difficult biliary cannulation in endoscopic retrograde cholangiopancreatography (ERCP) can result in failure of common bile duct (CBD) stone removal and pancreatitis. The present study aimed to report the efficacy and safety of limited precut sphincterotomy (PS) combined with endoscopic papillary balloon dilation (EPBD) for CBD stone removal in patients with difficult biliary cannulation, and the complications associated with this combined procedure.
  
  
  METHODS
  A total of 3305 patients underwent ERCP in our hospital between October 2009 and September 2014 and 258 were diagnosed with difficult biliary cannulation. Of these 258 patients, 58 underwent limited PS combined with EPBD for CBD stone removal, and these 58 patients were included in this retrospective study.
  
  
  RESULTS
  The overall success rate was 94.8 % (55/58), and the success rate for single-session removal was 87.9 % (51/58). The mean procedure time was 41 ± 11.48 min (range, 20-72 min). Mechanical lithotripsy was needed in 10.3 % (6/58) of patients. Procedure-related complications included bleeding in 3.4 % (2/58), pancreatitis in 8.6 % (5/58) and biliary tract infection (BTI) in 1.7 % (1/58) of patients.
  
  
  CONCLUSIONS
  The therapeutic outcome of limited PS combined with EPBD for CBD stone removal in patients with difficult biliary cannulation was good with an acceptable complication rate. It could be an alternative to PS and "early" limited PS should be used for prompt identification of the bile duct. Limited PS combined with EPBD is safe and effective for CBD stone removal in patients with difficult biliary cannulation.
authors.affiliation: Department of Internal Medicine, Division of Hepato-Gastroenterology, Kaohsiung Chang Gung Memorial Hospital, 123 Ta Pei Road, Niao-Sung Dist. 833, Kaohsiung City, Taiwan.|Chang Gung University College of Medicine, Kaohsiung, Taiwan.
authors.forename: Chung-Mou
authors.initials: CM
authors.lastname: Kuo
authors.affiliation: Department of Internal Medicine, Division of Hepato-Gastroenterology, Kaohsiung Chang Gung Memorial Hospital, 123 Ta Pei Road, Niao-Sung Dist. 833, Kaohsiung City, Taiwan.|Chang Gung University College of Medicine, Kaohsiung, Taiwan.
authors.forename: Yi-Chun
authors.initials: YC
authors.lastname: Chiu
authors.affiliation: Department of Internal Medicine, Division of Hepato-Gastroenterology, Kaohsiung Chang Gung Memorial Hospital, 123 Ta Pei Road, Niao-Sung Dist. 833, Kaohsiung City, Taiwan.|Chang Gung University College of Medicine, Kaohsiung, Taiwan.
authors.forename: Chih-Ming
authors.initials: CM
authors.lastname: Liang
authors.affiliation: Department of Internal Medicine, Division of Hepato-Gastroenterology, Kaohsiung Chang Gung Memorial Hospital, 123 Ta Pei Road, Niao-Sung Dist. 833, Kaohsiung City, Taiwan.|Chang Gung University College of Medicine, Kaohsiung, Taiwan.
authors.forename: Lung-Sheng
authors.initials: LS
authors.lastname: Lu
authors.affiliation: Department of Internal Medicine, Division of Hepato-Gastroenterology, Kaohsiung Chang Gung Memorial Hospital, 123 Ta Pei Road, Niao-Sung Dist. 833, Kaohsiung City, Taiwan.|Chang Gung University College of Medicine, Kaohsiung, Taiwan.
authors.forename: Wei-Chen
authors.initials: WC
authors.lastname: Tai
authors.affiliation: Department of Internal Medicine, Division of Hepato-Gastroenterology, Kaohsiung Chang Gung Memorial Hospital, 123 Ta Pei Road, Niao-Sung Dist. 833, Kaohsiung City, Taiwan.|Chang Gung University College of Medicine, Kaohsiung, Taiwan.
authors.forename: Yuan-Hung
authors.initials: YH
authors.lastname: Kuo
authors.affiliation: Department of Internal Medicine, Division of Hepato-Gastroenterology, Kaohsiung Chang Gung Memorial Hospital, 123 Ta Pei Road, Niao-Sung Dist. 833, Kaohsiung City, Taiwan.|Chang Gung University College of Medicine, Kaohsiung, Taiwan.
authors.forename: Cheng-Kun
authors.initials: CK
authors.lastname: Wu
authors.affiliation: Department of Internal Medicine, Division of Hepato-Gastroenterology, Kaohsiung Chang Gung Memorial Hospital, 123 Ta Pei Road, Niao-Sung Dist. 833, Kaohsiung City, Taiwan.|Chang Gung University College of Medicine, Kaohsiung, Taiwan.
authors.forename: Seng-Kee
authors.initials: SK
authors.lastname: Chuah
authors.affiliation: Department of Internal Medicine, Division of Hepato-Gastroenterology, Kaohsiung Chang Gung Memorial Hospital, 123 Ta Pei Road, Niao-Sung Dist. 833, Kaohsiung City, Taiwan.|Chang Gung University College of Medicine, Kaohsiung, Taiwan.
authors.forename: Chi-Sin
authors.initials: CS
authors.lastname: Changchien
authors.affiliation: Department of Internal Medicine, Division of Hepato-Gastroenterology, Kaohsiung Chang Gung Memorial Hospital, 123 Ta Pei Road, Niao-Sung Dist. 833, Kaohsiung City, Taiwan. grantkuo1107@gmail.com.|Chang Gung University College of Medicine, Kaohsiung, Taiwan. grantkuo1107@gmail.com.
authors.forename: Chung-Huang
authors.initials: CH
authors.lastname: Kuo
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000379:methods; D004106:Dilatation / Q000379:methods*; D005260:Female; D042882:Gallstones / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016717:Sphincterotomy, Endoscopic / Q000379:methods*; D016896:Treatment Outcome
keywords: Common bile duct stones; Difficult biliary cannulation; Endoscopic papillary balloon dilation; Endoscopic sphincterotomy; Precut sphincterotomy