Clinical Research About Removing Common Bile Duct Stones With Endoscopic Papillary Large Balloon Dilation

Background and objective:Endoscopic sphincterotomy(EST)combined with endoscopic papillary large balloon dilation(EPLBD)has been proven safe and effective to remove bile duct stones.However,recent studies indicate that EPLBD without EST may be safe and effective in managing the bile duct stones.Therefore,we conducted a retrospective research to compare the two different methods to investigate the safety and efficacy of EPLBD alone in the treatment of bile duct stones.Methods:This retrospective study included 111 patients who met the research criteria.All the patients,with bile duct stones,underwent endoscopic retrograde cholangiopancreatography(ERCP)between January 2012 and December 2016 at the digestive endoscopy center of Qilu Hospital,Shandong University.We analyzed the stone removal condition,short-term complications and long-term complications.Inclusion criteria:age ≥18 years,diagnosed with bile duct stones by the clinical symptoms and signs,medical history,abdominal ultrasound,abdominal CT,magnetic resonance cholangiopancreatography and/or other accessory examinations;maximum stone diameter≥0mm.Exclusion criteria:prior EST or EPBD;blood coagulation dysfunction(PLT<70×109/L or APTT prolong 2 times);acute pancreatitis.Results:A total of 111 patients with bile duct stones who met the research criteria were included:20 patients underwent EPLBD with EST(mean age,62.35 years)and 91 patients underwent EPLBD without EST(mean age,67.02 years);the maximum stone diameter were 13.70mm and 14.79mm,respectively;overall complete stone removal were achieved in 19(95.0%)and 87(95.60%)patients,respectively,with no statistical significance(P>0.05);successful stone removal in the first session,were achieved in 19(95.0%)and 86(94.51%)patients,respectively,with no statistical significance(P>0.05);mechanical lithotripsy were required in 1(5.0%)and 12(13.19%)patients,respectively,with no statistical significance(P>0.05);short-term complications’ comparison:acute pancreatitis occurred in 0(0%)and 5(5.49%)patients,respectively,with no statistical significance(P>0.05);cholangitis occurred in 1(5%)and 3(3.30%)patients,respectively,with no statistical significance(P>0.05);perforation occurred in 0(0%)and 1(1.10%)patients,respectively,with no statistical significance(P>0.05);In all,18 patients in the ESLBD group and 74 patients in the EPLBD alone group were followed up for the analysis of long-term outcomes;Long-term complications’comparison:stone recurrence occurred in 2(11.11%)and 4(5.41%)patients,respectively,with no statistical significance(P>0.05);cholangitis occurred in 1(5.56%)and 0(0%)patients,respectively,with no statistical significance(P>0.05);cholecystitis occurred in 1(12.50%)and 1(2.38%)patients,respectively,with no statistical significance(P>0.05).Conclusion:There are no difference between the ESLBD group and EPLBD alone group in the rate of overall successful stone removal,successful stone removal in 1 session,mechanical lithotripsy requirement,short-term complications and long-term complications.Therefore,EPLBD alone is a safe and effective therapy for patients with bile duct stones.