Comparison Of Endoscopic Sphincterotomy And Endoscopic Papillary Balloon Dilatation For Elderly Patients With Common Bile Duct Stones

Objective: To compare the effectiveness and safety of endoscopic sphincterotomy and endoscopic papillary balloon dilatation in the treatment of elderly patients with common bile duct stones,and to analyze the superiority of the procedure.Methods: Seventy-eight elderly patients(≥65 years old)with common bile duct stones who were admitted to the Department of Hepatobiliary Surgery of Wuhu NO.2People’s Hospital from December 2016 to February 2018 were enrolled.They were randomized to an endoscopic sphincterotomy or endoscopic papillary balloon dilatation group according to the random number table method.The operation duration,success rate for complete removal of stones,number of session,usage of mechanical lithotripsy,length of postoperative hospital stay,and incidence of early and long-term postoperative complications were compared between the two groups.Results: Complete duct clearance was achieved in 97.5%(39/40)in the endoscopic sphincterotomy group and 92.1%(35/38)in the endoscopic papillary balloon dilatation group(p>0.05,not significant).There was no significant difference between groups in terms of the number of session,usage of mechanical lithotripsy and length of postoperative hospital stay.The operation duration of EPBD is higher than EST(P <0.05)。 Early complications occurred in 10.0% of patients in the endoscopic sphincterotomy group and 13.1% of those in the endoscopic papillary balloon dilatation group(not significant).No serious complications such as perforation or death.Therewas no significant difference between groups in terms of cholangitis and pancreatitis.Hemorrhage occurred only in the endoscopic sphincterotomy group.The patients were followed up annually after the treatment.The duration of the follow-up was 1 year.Recurrent bile duct stones were observed in 7.5%(3/40)and 5.3%(2/38)of the patients who underwent EST and EPBD,respectively(P>0.05).The incidence rate of cholangitis in EST group is higher than EPBD(p<0.05).There were no biliary tumors in either group.Conclusion: Endoscopic sphincterotomy and endoscopic papillary balloon dilatation were approximately equal in terms of successful clearance of bile duct stones.They were also similar with respect to complications.However,the incidence of long-term complications of EPBD is lower than that of EST,and the shortening of the operation time after technical skill makes EPBD more advantageous.