International Journal of Multidisciplinary Research and Development

International Journal of Multidisciplinary Research and Development


International Journal of Multidisciplinary Research and Development
International Journal of Multidisciplinary Research and Development
Vol. 5, Issue 4 (2018)

Comparative study between endoscopic papillary balloon dilation and endoscopic sphincterotomy for enlargement of papillary opening during endoscopic removal of common bile duct stones


Dr. Gamal Muammad Soliman, Dr. Ibrahim Sabry Bakr, Dr. Ahmad Alwasif

Background: Traditionally, endoscopic sphincterotomy (EST) has been accepted as a part of the standard therapy for common bile duct (CBD) stone extraction. However, this procedure is associated with serious complications such as hemorrhage, pancreatitis, perforation, and permanent functional loss of the sphincter of Oddi that predispose to recurrent cholangitis.
Endoscopic papillary balloon dilation (EPBD) of the biliary sphincter was introduced as an alternative to EST, especially for patients with small or moderate CBD stones. By using the wire-guided method, EPBD could be easily performed. EPBD possesses the advantages of preserving papillary sphincter function and reducing the chance of hemorrhage and perforation. On the other hand it is associated with a high risk of pancreatitis.
Combined EPLBD after limited EST was introduced for the removal of large (≥ 10 mm) or multiple bile duct stones. This method increased the efficacy of stone extraction and minimized complications compared to both standard EST and EPBD.
The present study aimed to compare the success and complications rates between endoscopic papillary balloon dilation and endoscopic sphincterotomy for widening of the papillary opening during endoscopic removal of common bile duct stones.
Methods: A case control study was conducted on one hundred and forty eight patients who presented with calcular obstructive jaundice eligible to undergo therapeutic ERCP procedure. Patients were divided into two groups, Group I: eighty six patients who underwent EST combined with balloon catheters and/or baskets, and Group II; sixty two patients who underwent EPLBD technique combined with balloon catheters and/or baskets for stone extraction.
Results: Complete CBD stones clearance among the patients of group I; EST was effective in (96%) of patients with the stone sized < 1 cm, while stone clearance occurred in (56%) in patient with stone size > 1cm, (overall clearance rate=79%). Overall adverse effects of patients of group 1 was (18.5%)
Whereas complete extraction CBD stones among the patients of group II; EPLBD was effective for clearance of (92.5%) of CBD stones in patients with the stone sized < 1cm and in (83%) of patients with stone size > 1cm, (overall clearance rate=87%). Overall adverse effects of patients of group II was (29%).
Conclusion: Endoscopic papillary large balloon dilation is an adjunctive safe tool to endoscopic sphincterotomy for removing large or difficult CBD stones.
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How to cite this article:
Dr. Gamal Muammad Soliman, Dr. Ibrahim Sabry Bakr, Dr. Ahmad Alwasif. Comparative study between endoscopic papillary balloon dilation and endoscopic sphincterotomy for enlargement of papillary opening during endoscopic removal of common bile duct stones. International Journal of Multidisciplinary Research and Development, Volume 5, Issue 4, 2018, Pages 55-60
International Journal of Multidisciplinary Research and Development