title: Feasibility of Endoscopic Papillary Large Balloon Dilation in Patients with Difficult Bile Duct Stones without Dilatation of the Lower Part of the Extrahepatic Bile Duct.
abstract: OBJECTIVE
  There is no consensus for using endoscopic papillary large balloon dilation (EPLBD) in patients without dilatation of the lower part of the bile duct (DLBD). We evaluated the feasibility and safety of EPLBD for the removal of difficult bile duct stones (diameter ≥10 mm) in patients without DLBD.
  
  
  METHODS
  We retrospectively reviewed the records of 209 patients who underwent EPLBD for the removal of bile duct stones from October 2009 to July 2014. Primary outcomes were the clearance rate and additional mechanical lithotripsy. Secondary outcomes were the incidence of complications and recurrence rate.
  
  
  RESULTS
  Fiftyseven patients had DLBD (27.3%), and 152 did not have DLBD (72.7%). There were no significant differences in the overall success rate or the use of mechanical lithotripsy. Success rate during the first session and procedure time were better in the DLBD than the without-DLBD group (75.7% vs 66.7%, 48.1±23.0 minutes vs 58.4±31.7 minutes, respectively). As for complications, there were no significant differences in the incidence of pancreatitis, perforation or bleeding after endoscopic retrograde cholangiopancreatography. The recurrence rate did not differ significantly between the two groups.
  
  
  CONCLUSIONS
  EPLBD is a useful and safe method for common bile duct stone removal in patients without DLBD.
authors.affiliation: Department of Gastroenterology and Hepatology, Yokohama City University School of Medicine, Yokohama, Japan.
authors.forename: Yuji
authors.initials: Y
authors.lastname: Fujita
authors.affiliation: Department of Gastroenterology and Hepatology, Yokohama City University School of Medicine, Yokohama, Japan.
authors.forename: Akito
authors.initials: A
authors.lastname: Iwasaki
authors.affiliation: Department of Gastroenterology and Hepatology, Yokohama City University School of Medicine, Yokohama, Japan.
authors.forename: Takamitsu
authors.initials: T
authors.lastname: Sato
authors.affiliation: Department of Gastroenterology, NTT Tokyo Medical Center, Tokyo, Japan.
authors.forename: Toshio
authors.initials: T
authors.lastname: Fujisawa
authors.affiliation: Department of Gastroenterology and Hepatology, Yokohama City University School of Medicine, Yokohama, Japan.
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Sekino
authors.affiliation: Department of Gastroenterology and Hepatology, Yokohama City University School of Medicine, Yokohama, Japan.
authors.forename: Kunihiro
authors.initials: K
authors.lastname: Hosono
authors.affiliation: Department of Gastroenterology, NTT Tokyo Medical Center, Tokyo, Japan.
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Matsuhashi
authors.affiliation: Department of Medical Statistic, Yokohama City University School of Medicine, Yokohama, Japan.
authors.forename: Kentaro
authors.initials: K
authors.lastname: Sakamaki
authors.affiliation: Department of Gastroenterology and Hepatology, Yokohama City University School of Medicine, Yokohama, Japan.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Nakajima
authors.affiliation: Department of Gastroenterology and Hepatology, Yokohama City University School of Medicine, Yokohama, Japan.
authors.forename: Kensuke
authors.initials: K
authors.lastname: Kubota
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D014670:Ampulla of Vater / Q000601:surgery*; D017734:Bile Ducts, Extrahepatic / Q000601:surgery; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000379:methods*; D042883:Choledocholithiasis / Q000601:surgery*; D004106:Dilatation / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D010195:Pancreatitis / Q000453:epidemiology; D011183:Postoperative Complications / Q000453:epidemiology; D019106:Postoperative Hemorrhage / Q000453:epidemiology; D012189:Retrospective Studies
keywords: Cholangiopancreatography, endoscopic retrograde; Common bile duct stone