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Endoscopic papillary large balloon dilation for the management of recurrent difficult bile duct stones after previous endoscopic sphincterotomy
Author(s) -
Yoon Hyung Geun,
Moon Jong Ho,
Choi Hyun Jong,
Kim Dong Choon,
Kang Myung Soo,
Lee Tae Hoon,
Cha SangWoo,
Cho Young Deok,
Park SangHeum,
Kim SunJoo
Publication year - 2014
Publication title -
digestive endoscopy
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.5
H-Index - 56
eISSN - 1443-1661
pISSN - 0915-5635
DOI - 10.1111/den.12102
Subject(s) - medicine , balloon dilation , lithotripsy , endoscopic retrograde cholangiopancreatography , bile duct , hyperamylasemia , common bile duct , balloon , surgery , pancreatitis , asymptomatic , chemistry , enzyme , amylase , biochemistry
Background Endoscopic management of recurrent bile duct stones after endoscopic sphincterotomy ( EST ) is effective and safe. However, repeat EST for extension of a previous EST for recurrent bile duct stones may involve substantial risk. The aim of the present study was to evaluate the safety and efficacy of endoscopic papillary large balloon dilation ( EPLBD ) without repeat EST for recurrent difficult bile duct stones after previous EST . Patients and Methods From J anuary 2006 to O ctober 2010, a total of 52 patients were enrolled; all had undergone EPLBD (balloon diameter: 12–20 mm) to remove recurrent difficult bile duct stones after previous EST . In all patients, stone removal had failed with conventional methods using a basket and/or balloon. The size of the balloon for EPLBD was selected to fit the diameter of the common bile duct or the largest stone. Results The median interval between initial EST and stone recurrence was 2.2 years (range 1–10). Median diameters of thelargest stone and balloon were 20.1 mm (range 12–40) and 14.7 mm (range 12–20), respectively. Complete stone removal was achieved in all patients (100%). The median number of endoscopic retrograde cholangiopancreatography sessions needed for complete stone removal was 1.6 (range 1–3). Additional lithotripsy was required in 16 patients (30.7%). No procedure‐related complications were documented, with the exception of four cases of asymptomatic hyperamylasemia. The recurrence rate of CBD stones after bile duct clearance was 17.3% (9/52) during the follow‐up period (mean 27.0 ± 14.1 months). Conclusions EPLBD without repeat EST is effective and relatively safe for the extraction of recurrent difficult bile duct stones after previous EST .