Comparison of the usefulness of endoscopic sphincterotomy, endoscopic papillary large-balloon dilation with combined approaches for common bile duct stones.
Publication Date : 21/07/2015
Objective: To investigate endoscopic teatment of common bile duct stones (CDS) in patients by sphincter small incision combined with balloon dilatation of the the efficacy and safety. Method: 296 patients with common bile duct stones treated in our department between July 2009 and July 2013, randomized comparison of SES +ELBD (group A, n = 104) and EPBD alone (group B, n = 96), traditional EST (group C, n = 96) for the treatment of CDS. A group underwent small incision endoscopic sphincterotomy (< 0.5cm), Wilson-cook, the balloon according to the size of stone and dilatation of common bile duct dilatation teat sphincter (diameter of 12, 15, 18mm), the position of the balloon adjustment under X-ray monitoring, balloon injection pressure 5atm, maintain 1min, intermittent 1min, expanding again 1 times, to fully expanded papillae group B, expansion method of operation with the above A group; C group adopts the push-pull papillotome, according to the size of stone, EST usually 10 ~ 15mm. After the stone basket stone, part of patients with stone to stone basket after mechanical lithotripsy(ML). Results: ERCP total success rate was 96.3% (285/296). Remove the complete stone rate once: 94.23% in A group and B group 91.67%, C group 83.75% patients, not a clear stones placed biliary drainage tube. Mechanical lithotripsy group A: 10/99 cases (10.10%), group B: 12/92 cases (13.04%), group C: 8/94, 8.51%. A group of 8/99 cases occurred complications (8.08%), group B: 10/92 cases (10.87%), C group17/94 cases (18.09%). 6 cases of acute pancreatitis after operation in A group, 2 cases of acute cholangitis, 4 cases of hemorrhage after operation in B group, 6 cases of acute pancreatitis after operation; 7 cases of hemorrhage after operation in C group, including 1 cases of endoscopic hemostasis, 10 cases of acute pancreatitis; were cured conservatively, no perforation occurred in three groups. A group and C group is a complete stone clearance rate were statistically significant (P <0.05), the complication rate of A group and C group had significant difference (P <0.05). Conclusion: SES +ELBD than the traditional EST on rates of successful stone removal in the first session is high, the low rate of complications of ERCP。 Key word:small endoscopic sphincterotomy; endoscopic papillary balloon dilatation; common duct stone; complication