Small sphincterotomy combined with endoscopic papillary large balloon dilation vs sphincterotomy alone for removal of common bile duct stones

AIM:To evaluate the efficacy and safety of endoscopic papillary large diameter balloon dilation(EPLBD)following limited endoscopic sphincterotomy(EST)and EST alone for removal of large common bile duct(CBD)stones.METHODS:We retrospectively compared EST+EPLBD(group A,n=64)with EST alone(group B,n=89)for the treatment of large or multiple bile duct stones.The success rate of stone clearance,procedure-related complications and incidents,frequency of mechanical lithotripsy use,and recurrent stones were recorded.RESULTS:There was no statistically significant difference between the two groups regarding periampullary diverticula(35.9%vs 34.8%,P>0.05),pre-cut sphincterotomy(6.3%vs 6.7%,P>0.05),size(12.1±2.0mm vs 12.9±2.6 mm,P>0.05)and number(2.2±1.9vs 2.4±2.1,P>0.05)of stones or the diameters of CBD(15.1±3.3 mm vs 15.4±3.6 mm,P>0.05).The rates of overall stone removal and stone removal in the first session were not significantly different between the two groups[62/64(96.9%)vs 84/89(94.4%),P>0.05;and 58/64(90.6%)vs 79/89(88.8%),P>0.05,respectively].The rates of post-endoscopic retrograde cholangiopancreatography pancreatitis and hyperamylasemia were not significantly different between the two groups[3/64(4.7%)vs 4/89(4.5%),P>0.05;7/64(10.9%)vs 9/89(10.1%),P>0.05,respectively].There were no cases of perforation,acute cholangitis,or cholecystitis in the two groups.The rate of bleeding and the recurrence of CBD stones were significantly lower in group A than in group B[1/64(1.6%)vs 5/89(5.6%),P<0.05;1/64(1.6%)vs 6/89(6.7%),P<0.05,respectively].CONCLUSION:EST+EPLBD is an effective and safe endoscopic approach for removing large or multiple CBD stones.