Efficacy And Safety Of Endoscopic Papillary Large Balloon Dilatation In The Treatment Of Choledocholithiasis With Diverticula

Purposes:To evaluate the efficacy and safety of endoscopic papillary large balloon dilatation(Endoscopic papillary large balloon dilatation,EPLBD)in the treatment of choledocholithiasis with periampullary diverticula(periampullary diverticula,PAD).Methods:1.The clinical data of patients with choledocholithiasis treated with EPLBD in the Affiliated Hospital of Qingdao University from January 2013 to January 2018 were collected.According to the existence of PAD,they were divided into diverticula group(PAD)and non-diverticula group(N-PAD);according to the position relationship between PAD and nipple,they were divided into type 1,type 2 and type 3;and then according to the size of PAD,they were divided into large diverticula group,medium diverticula group and small diverticula group.2.Summarized the clinical data of patients with choledocholithiasis treated by EPLBD in our hospital,compared the general situation(Sex,age,past history,personal history,history of cholecystectomy,common bile duct diameter,stone size)and intraoperative(pre-incision,nipple incision,size of air bag,implantation of pancreatic duct stent,utilization rate of mechanical lithotripsy,indwelling nasobiliary duct)differences between N-PAD group and PAD group.According to the success rate of lithotomy,the differences between N-PAD group and PAD group,different types of PAD group and different size of PAD group were compared,and the results were discussed and analyzed.3.To compare the incidence of short-term complications(post-ERCP pancreatitis PEP,bleeding,perforation,cholangitis)between N-PAD group and PAD group,different types of PAD group and different size PAD group,and to evaluate the short-term effect of EPLBD in the treatment of choledocholithiasis patients with PAD.4.To summarize and analyze the differences of long-term complications(stone recurrence,cholangitis,gas in bile duct)between non-PAD group and PAD group,different types of PAD group and different size of PAD group,and to discuss the effect of PAD on the long-term complications of EPLBD in patients with choledocholithiasis.Results:1.A total of 508 eligible patients were selected,including 193 patients in the N-PAD group and 315 patients in the PAD group.There were 145 patients in type 1 PAD group,143 patients in type 2 PAD group and 27 patients in type 3 PAD group.There were 63 patients in small PAD group,168 patients in medium PAD group and 84 patients in large PAD group.2.The average age of PAD group was higher than that of N-PAD group(P=0.032).The number of male patients in the PAD group was higher than that in the N-PAD group(P = 0.032),and there were no significant difference between the two groups except for age and gender.There were no significant difference in pre-incision,nipple incision,balloon size,pancreatic duct stent implantation,lithotripsy utilization rate and indwelling nasobiliary duct between N-PAD group and PAD group.There were no significant difference between different types of PAD groups and different size of PAD groups.3.Short-term complications: There were no significant difference in the incidence of PEP between the N-PAD group and the PAD group(P=0.089).There were no significant difference in the incidence of bleeding,perforation,cholangitis between two groups.There were no significant difference in the incidence of short-term complications among different types of diverticula.There were no significant difference in the incidence of postoperative bleeding and cholangitis among different size diverticula groups.There were a significant difference in the incidence of PEP between different sizes of PAD(P=0.007),the incidence of PEP in the small PAD group were significantly higher than that in the large and medium PAD groups.4.Long-term complications: The average follow-up period was 37.95 months,and347 patients were included in the study.There were 42 patients with stone recurrence,and the overall recurrence rate was 12.1%.There were 123 cases in the N-PAD group,the stone recurrence rate was 17.1% in the PAD group,and the stone recurrence rate was9.3%.There were significant differences in the recurrence rate of choledocholithiasis and the incidence of gas in the bile duct between the two groups(P=0.035?P=0.001).The recurrence rate of stones and the incidence of gas in the bile duct were higher in the N-PAD group.There were no significant difference in the incidence of long-term complications among different types and sizes of PAD.Conclusions1.The existence,type and size of PAD do not affect the success rate of EPLBD in the treatment of choledocholithiasis.2.EPLBD is safe in the treatment of choledocholithiasis complicated with PAD,and the existence and type of PAD do not affect the short-term postoperative complications.3.Small diverticula increases the risk of pancreatitis after EPLBD.4.EPLBD is safe in the treatment of choledocholithiasis with PAD.The existence,type and size of PAD do not affect the long-term complications after EPLBD.