Retrospective Analysis Of Endoscopic Papillary Large Balloon Dilatation Alone For The Treatment Of Large Common Bile Duct Stone

Objective To evaluate the efficacy and safety of endoscopic papillary large balloon dilatation alone and endoscopic sphincterotomy for the treatment of large common bile duct stones,in order to confirm EPLBD alone is an effective and safe method.Methods From January 2014 to December 2017,we conducted a retrospective study to investigate the effect of the method of EPLBD and EST in patients with large CBDS in the Endoscopy Center of the First Affiliated Hospital of Inner Mongolia Medical University to in order to evaluate the efficacy and safety of EPLBD alone in the treatment of large CBDS.There were 59 patients in the EPLBD group and 51 patients in the EST group.The data of the age,sex,presence of duodenal papillary diverticulum,combined with gallstones or cholecystectomy,and the acute cholangitis were analyzed.The size and number of common bile duct stones,the diameter of common bile duct in each group should be measured.The first success rates of stone removal,the frequency of use of mechanical lithotripter,the ERCP times and the short-term and long-term complications were compared between the groups.Results For the EPLBD group(59 cases)and the EST group(51 cases),there were no significant differences in the general analysis of the diameter and number of stones(P>0.05).The total success rate of stone removal in the two groups were98.3% and 96.1% respectively.Successful stone removals in the first session were achieved in 81.4% and 76.5% respectively,with no statistical difference in the success rate of stone removal(P>0.05).But the EPLBD group has a higher stone success rate in the first session than the EST group.The mechanical lithotripter were required in11.9% in the EPLBD group and 27.5% in the EST group,with statistically significance(P<0.05),.Short-term and long-term complications comparison: acute pancreatitis did not occur in the EPLBD group(0/59),1 case of mild acutepancreatitis occurred in EST,and cured after conservative treatment;the incidence of intraoperative bleeding in the EPLBD and EST groups were 3.4% and 5.9%respectively,with no significant statistically difference(P>0.05).And about the incidence of recurrence of common bile duct stones between the two groups were(3.4% vs 3.9%,P>0.05),with no significant statistically difference.There were no perforation or death in the two groups.Conclusion There were no significant differences in total stone removal success rate,postoperative complication rate in the EPLBD group and the EST group.The success stone removals in the first session in the EPLBD was higher than the EST,and the frequency of use of mechanical lithotripter was low in the EPLBD group.Therefore,EPLBD is an effective and safe method for the treatment of large common bile duct stones because it causes mild injury to the nipple sphincter,and it is not susceptible to be impacted by the nipple size and variation factors.