Original Article: Clinical EndoscopyEndoscopic sphincterotomy plus large-balloon dilation versus endoscopic sphincterotomy for removal of bile-duct stones
Section snippets
Patients
Inclusion criteria were the following: (1) choledocholithiasis, 40 mm or less in maximum shorter diameter (ie, the shorter diameter of the largest stone) and (2) deep cannulation of the bile ducts, with or without needle-knife sphincterotomy. Exclusion criteria included coagulopathy (international normalized ratio [INR] > 1.5), platelet count <50,000/mL, anticoagulation therapy within 72 hours of the procedure, acute pancreatitis, septic shock, prior EST, Billroth II or Roux-en-Y anatomy, stone
Methods
ERCP was done with side-viewing endoscopes (JR-240 or TJF-240; Olympus Optical Co, Ltd, Tokyo, Japan). The Olympus electrosurgical unit (UES-30; Olympus) was used at a setting of blended 1 current with a power setting of 40 W/s for both the cut and coagulation currents (cut:coagulation ratio, 4:1). The 2 endoscopists who participated in this study had considerable experience, based on their performance of more than 300 biliary interventions per year. The patients were sedated with a standard
Results
There was no difference between groups 1 and 2 with regard to prothrombin time/INR (1.12 ± 0.3 vs 1.15 ± 0.2, P = .562), periampullary diverticulum (49.0% vs 45.0%, P = .571), pre-cut sphincterotomy (12.0% vs 18.0%, P = .235), or size (16.0 ± 0.7 mm vs 15.0 ± 0.7 mm, P = .283) and number (2.7 ± 2.7 vs 2.2 ± 1.0, P = .141) of stones.
In the first session, stone clearance did not differ significantly between the 2 groups, with 83.0% for group 1 versus 87.0% for group 2, P = .428. In patients whose
Discussion
EST is the most commonly used technique for the removal of bile-duct stones. However, EST carries substantial procedure-related risks, such as hemorrhage and perforation, and perhaps an increased incidence of ascending cholangitis and de novo formation of bile-duct stones, especially in younger patients.3, 17, 18, 19 EPBD has been advocated as an alternative, because it is thought to preserve sphincter of Oddi function and reduce complications, such as hemorrhage and perforation, compared with
Acknowledgments
We thank Myung Hwan Kim, MD, and Ji Ho Lee, MD (University of Ulsan), for their advice and assistance.
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