The Research Of ESLBDAnd EST For Large And Multiple Common Bile Duct Stones In Elderly Patients

Objective: Endoscopic sphincterotomy(EST) is currently recognized as one of the priamary endopscopic treatment for common bile duct stones.However,it is difficult to remove multiple(≥3) or large(≥12mm)common bile duct stones with EST alone.Recent lots of studies has shown that endoscopic sphincterotomy plus endoscopic papillary large balloon dilation(ESLBD) is regarded as an effective modality for treating difficult common bile duct stones.Our study is to evaluate the safety and effectiveness of ESLBD and EST in elderly patients for bile duct stones that were difficult to treat using EST alone.We also compared the complication rates between the techniques.Methods: 118 elderly patients with large(largest diameter, ≥12mm) or≥3 common bile duct stones treated in our department between March 2014 and March 2015 underwent ESLBD(n=63) or EST alone(n=55).We compared final successful stone removal rate,rate of successful stone removal in the first session,no of session,procedure times,status of concurrent mechanical lithotripsy(ML),hospitalization and complications between the ESLBD and EST groups. The ESLBD group of 63 patients were randomly assigned to undergo ESLBD with a 30 or 60 second duration with balloon dilators sized form 10 to 20 mm. To compare the effect of the two different dilating duration on the complications which involves hyperamylasermia,acute pancreatitis, gastrointestinal bleeding, biliary tract infection and perforation after surgery.In this study,we perform ultrasonography erery 3months for all of patients,to evaluated short-term follow-up results about recurrent stones.Statistical Analysis: All data was analyzed using the Statistical Packagefor Social Science(version 19.0, SPSS Inc, Chicago, IL). Independent samples t-test was used for the mean comparison. Agreement between two groups was calculated, and the difference was evaluated using the Chi-square test or Fisher’s exact test when appropriate. A p value of less than 0.05 was considered statistically signi?cant.Results:The rates of final successful stone removal was significantly higher in the ESLBD group( ELSBD:100% vs EST:92.27%; p=0.044).The rate of successful stone removal in the first session was significantly higher in the ESLBD group( ELSBD:95.23% vs EST:78.43%; p=0.009).Moreover,the procedure time was significantly shorter(ELSBD:32.27 min vs EST:41.56min; p<0.001) and the rate of ML use was significantly lower in the ESLBD group(ELSBD:11.11% vs EST:45.45%; p<0.001).The rate of recent complications like pancreatitis,hemorrhage,infection and perforation were similar between the two groups,the differences were not statistically significant(ELSBD:11.11% vs EST:14.54%; p=0.593).Common bile duct stone recurrence occurred in one patient in the ESLBD group and six patients in the EST group during 6 months follow-up period, the differences were not statistically significant(ELSBD:1.58% vs EST:11.76%; p=0.044).Long-term follow up is needed.Conclusion: Our results suggest that ESLBD is an effective therapy for elderly patients with difficult-to-treat multiple of large common bile stones,because it requires fewer sessions and shorter operative times than EST alone without increasing the number of accidental enents.