The Safety and Effectiveness of Medium Endoscopic Sphincterotomy with Endoscopic Papillary Large Balloon Dilation for Removing Difficult Common Bile Duct Stones

Korean J Gastrointest Endosc > Volume 35(2); 2007 > Article

Korean Journal of Gastrointestinal Endoscopy 2007;35(2): 80-86.

제거가 어려운 총담관 결석 치료에서 내시경 유두괄약근 중절개술과 내시경 유두 큰 풍선 확장술 병용요법의 안정성과 효용성

이선해․홍성욱․조영덕․천영국․김상균․장재영·김영석․문종호․이준성․이문성․심찬섭․김부성

순천향대학교 의과대학 내과학교실, 소화기연구소

The Safety and Effectiveness of Medium Endoscopic Sphincterotomy with Endoscopic Papillary Large Balloon Dilation for Removing Difficult Common Bile Duct Stones

Sun Hae Lee, M.D., Sung Wook Hong, M.D., Young Deok Cho, M.D., Young Koog Cheon, M.D., Sang Gyun Kim, M.D., Jae Young Jang, M.D., Young Seok Kim, M.D., Jong Ho Moon, M.D., Joon Seong Lee, M.D., Moon Sung Lee, M.D., Chan Sup Shim, M.D. and Boo Sung Kim, M.

Abstract

Background/Aims:
Mechanical lithotripsy is generally used when it is difficult to endoscopically remove common bile duct (CBD) stones. However, this procedure not only requires extensive experience, but it is also time consuming. Medium endoscopic sphincterotomy (medium EST) combined with endoscopic papillary large balloon dilation (EPLBD) is recently being increasingly used; therefore, the aim of this study was to evaluate the safety and effects of medium EST with EPLBD for patients with CBD stones that are difficult to remove.
Methods:
41 patients with CBD stones that were difficult to remove by conventional endoscopic methods were enrolled in this study. EPLBD was performed after medium EST. The size of the stones, the procedure time, complications and the total number of sessions needed for stone removal were analyzed.
Results:
The mean size of the CBD stones was 18.2 ⁑ 7.7 mm, and the mean number of stones was 2.7. Additional mechanical lithotripsy for complete removal was required in 9.7% (4/41) of the patients. Procedure related complications occurred in 7% (3/41): bleeding in 1 case and acute pancreatitis in 2 cases.
Conclusions:
Medium EST with EPLBD was a safe and effective treatment modality for CBD stones that were difficult to remove. Further prospective randomized studies are needed for comparing the effectiveness and safety between conventional EST and medium EST with EPLBD for removing difficult CBD stones.

Key Words: Endoscopic papillary large balloon dilation, Medium endoscopic sphincterotomy, Bile duct stones

주요어: 내시경 유두괄약근 중절개술, 내시경 유두 큰 풍선 확장술, 총담관 결석