title: [Large balloon dilation for removal of choledocholithiasis difficult to extract: clinical experience].
abstract: OBJECTIVE
  The aim of this study was to report the initial experience of the combined use of biliary sphincterotomy plus balloon dilatation of the papilla for management of large stones.
  
  
  METHODS
  Design: Retrospective, descriptive. This study included 18 patients in whom a hydrostatic dilatation of the papilla with large balloons was performed between June 2012 and April 2014. Patients had multiple large stones, tapered distal common bile duct, previous sphincterotomy, or peri/ intradiverticular papilla. CRE™ dilatation balloons with diameters ranging from 12 to 20 mm were used. Data were recorded as successful procedure, use of lithotripsy and complications during the procedure.
  
  
  RESULTS
  The average age was 66.1 years. There was a predominance of the female gender (66.7%). The average size of the bile duct stones was 16.7 mm. The main indications were: giant choledocholithiasis (12 patients, 66.7%) and tapered distal common bile duct (6 patients, 33.3%). The dilatation balloons diameter used were: 15 mm (8 patients, 44.4%), 18 mm (5 patients, 27.8%), 12 mm (3 patients, 16.7%) and 20 mm (2 patients, 11.1%). Complete stone clearance was achieved in 15 patients (83.3%). Lithotripsy was performed in 4 patients (22.2%). There were 3 patients in whom the removal with balloon was unsuccessful, performed surgical management. It was reported 1 case of mild acute pancreatitis (5.5%).
  
  
  CONCLUSIONS
  The results show that endoscopic papillary large balloon dilation after sphincterotomy is a safe and effective technique for treatment of difficult bile duct stones.
authors.affiliation: Departamento del Aparato Digestivo, Hospital Nacional Edgardo Rebagliati Martins, EsSalud. Lima, Perú.
authors.forename: Luis
authors.initials: L
authors.lastname: Marin Calderón
authors.affiliation: Departamento del Aparato Digestivo, Hospital Nacional Edgardo Rebagliati Martins, EsSalud. Lima, Perú.
authors.forename: Augusto
authors.initials: A
authors.lastname: Vera Calderón
authors.affiliation: Departamento del Aparato Digestivo, Hospital Nacional Edgardo Rebagliati Martins, EsSalud. Lima, Perú.
authors.forename: Aldo
authors.initials: A
authors.lastname: Gómez Correa
authors.affiliation: Departamento del Aparato Digestivo, Hospital Nacional Edgardo Rebagliati Martins, EsSalud. Lima, Perú.
authors.forename: Zenon
authors.initials: Z
authors.lastname: Cervera Reyes
authors.affiliation: Departamento del Aparato Digestivo, Hospital Nacional Edgardo Rebagliati Martins, EsSalud. Lima, Perú.
authors.forename: Milagros
authors.initials: M
authors.lastname: Dávalos Moscol
authors.affiliation: Departamento del Aparato Digestivo, Hospital Nacional Edgardo Rebagliati Martins, EsSalud. Lima, Perú.
authors.forename: Edgar
authors.initials: E
authors.lastname: Alva Alva
authors.affiliation: Departamento del Aparato Digestivo, Hospital Nacional Edgardo Rebagliati Martins, EsSalud. Lima, Perú.
authors.forename: Fernando
authors.initials: F
authors.lastname: Palacios Salas
authors.affiliation: Departamento del Aparato Digestivo, Hospital Nacional Edgardo Rebagliati Martins, EsSalud. Lima, Perú.
authors.forename: Ramiro
authors.initials: R
authors.lastname: Díaz Ríos
authors.affiliation: Departamento del Aparato Digestivo, Hospital Nacional Edgardo Rebagliati Martins, EsSalud. Lima, Perú.
authors.forename: Edson
authors.initials: E
authors.lastname: Guzmán Calderón
authors.affiliation: Hospital Nacional Edgardo Rebagliati Martins, EsSalud. Lima, Perú.
authors.forename: Grisley
authors.initials: G
authors.lastname: García Chihuan
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002760:Cholangiopancreatography, Endoscopic Retrograde; D042883:Choledocholithiasis / Q000000981:diagnostic imaging / Q000628:therapy*; D003131:Combined Modality Therapy; D004106:Dilatation / Q000295:instrumentation / Q000379:methods*; D005260:Female; D006801:Humans; D008096:Lithotripsy; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016717:Sphincterotomy, Endoscopic; D016896:Treatment Outcome