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Open Access Research article

Endoscopic large-balloon dilation alone versus endoscopic sphincterotomy plus large-balloon dilation for the treatment of large bile duct stones

Jae Chul Hwang, Jin Hong Kim*, Sun Gyo Lim, Soon Sun Kim, Sung Jae Shin, Kee Myung Lee and Byung Moo Yoo

Author Affiliations

Department of Gastroenterology, Ajou University School of Medicine, San-5, Woncheon-dong, Yongtong-gu 443-721 Suwon, Korea

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BMC Gastroenterology 2013, 13:15  doi:10.1186/1471-230X-13-15

Published: 17 January 2013

Abstract

Background

Endoscopic sphincterotomy (EST) combined with large-balloon dilation (LBD) has been proposed as an alternative to manage large bile duct stones. However, recent reports indicate that LBD without EST may be safe and effective in this setting.

Methods

One hundred thirty-one patients with large common bile duct (CBD) stones 12 mm in size or larger underwent LBD alone (n = 62) or EST plus LBD (n = 69) for lithotripsy. The therapeutic outcome and complications were reviewed and compared.

Results

There were no differences between the two groups with regard to age, size and number of stones, or bile duct diameter. The LBD alone group (mean age, 70.4 years) and the EST plus LBD group (mean age, 68.2 years) had similar outcomes in terms of overall successful stone removal (96.8% vs. 95.7%, P = 0.738) and complete stone removal without the need for mechanical lithotripsy (80.6% vs. 73.9%, P = 0.360). Complications in the LBD alone and EST plus LBD groups were as follows: pancreatitis (6.5% vs. 4.3%, P = 0.593), impaction of basket and stone (0% vs. 1.4%, P = 0.341), and perforation (0% vs. 1.4%, P = 0.341).

Conclusions

LBD alone may be a simple, safe, and effective alternative to EST plus LBD in relatively aged patients with large CBD stones, and it can simplify the procedure compared with EST plus LBD.

Keywords:
Common bile duct stones; Endoscopic sphincterotomy; Large-balloon dilation