Stone-free Effect Of Small Endoscopic Sphincterotomy Plus Papillary Large Balloon Dilation For Removal Of Large Common Bile Duct Stones

Objectie: To investigate the clinical safety and effectiveness of small endoscopic sphincterotomy plus endoscopic papillary large balloon dilatation in the treatment of large common bile duct stones.Methods: 80 patients with large common bile duct stones(diameters 15–20 mm) who were treated between October 2012 and May 2014 in our hospital were randomly divided into two groups. We compared the therapeutic effects and complications of small endoscopic sphincterotomy plus endoscopic papillary large balloon dilatations(SEST+EPLBD; observation group) and conventional large endoscopic sphincterotomy plus endoscopic mechanical lithotripsy(control group) for the treatment of large common bile duct stones. The success rates of stone removal, procedure time, radiation exposure time, post-ERCP pancreatitis, postoperative hemorrhage, postoperative perforation, postoperative infection, and other complications were compared between the groups.Results: The complete stone removal in 1st session was successfully performed in 43 patients in the observation group(95.34%) and 37 patients in the control group(94.59%). There was no statistically significant difference in the complete stone removal rate between the two groups. However, there were significant differences in procedure times between the two groups. Procedure time was 26.09 ± 10.56 and 32.24±9.99 in the observation and control groups(P<0.01), respectively. The radiation exposure time differed significantly between the two groups(14.79±5.83 vs. 19.75±7.12 min, P<0.05, respectively). The incidence of short-term post-ERCP complications was 4.6%(2/43) and 11%(4/37), respectively, with no deaths reported during the course of the study. The incidence of postoperative complications such as hemorrhage and infection were significantly higher in the control group than in the observation group.Conclusion: Compared to the conventional method, SEST+EPLBD was more efficient and less time-consuming. SEST+EPLBD is a safe and effective new method, especially for theremoval of large common bile duct stones.