Short-term And Long-term Outcomes After Endoscopic Sphincterotomy Versus Endoscopic Papillary Balloon Dilation For Common Bile Duct Stones

Objective To compare the short-term and long-term outcomes of endoscopic sphincterotomy(EST)versus endoscopic papillary balloon dilation(EPBD)for common bile duct stones,and to investigate the risk factors for long-term complications.Methods From January 1st,2008 to June 6th 2011,patients who underwent endoscopic retrograde cholangiopancreatography(ERCP)for common bile duct stones removal in our hospital were retrospectively reviewed.Patients were divided into EST and EPBD groups,and the long-term follow-up results were obtained through telephone or by searching for the medical records since this hospitalization.Results A total of 863 patients were enrolled in this study,with 636 in the EST group and 227 in the EPBD group.The two groups had no statistical difference in the rate of complete stone removal.Except for post-ERCP pancreatitis,they had no difference in other early complications.In all,493 patients in the EST group and 170 patients in the EPBD group were followed up for 36.7 months to 77.6 months.More patients in the EST group had cholangitis,stone recurrence and cholecystitis.Multivariate analysis showed that,EPBD seemed to be a protective factor for cholangitis,stone recurrence and cholecystitis.Gall stones were risk factors for cholangitis and cholecystitis,and mechanical lithotripsy was a risk factor for stone recurrence.Conclusion EST was better than EPBD in terms of short-term outcomes,however,during long-term follow-up,patients in the EST group experienced more late complications.Gall stones and mechanical lithotripsy may be risk factors for the long-term complications.