Fujita Naotaka, Maguchi Hiroyuki, Komatsu Yutaka, Yasuda Ichiro, Hasebe Osamu, Igarashi Yoshinori, Murakami Akihiko, Mukai Hidekazu, Fujii Tsuneshi, Yamao Kenji, Maeshiro Kensei
Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan.
Gastrointest Endosc. 2003 Feb;57(2):151-5. doi: 10.1067/mge.2003.56.
Endoscopic papillary balloon dilatation may be an alternative to endoscopic sphincterotomy in the treatment of bile duct stones. However, there is a controversy as to the effectiveness and safety of endoscopic papillary balloon dilatation.
Two hundred eighty-two patients with bile duct stones were enrolled and randomized to an endoscopic sphincterotomy or endoscopic papillary balloon dilatation group. The success rate for duct clearance as well as the frequency and types of complications were evaluated prospectively. Endoscopic sphincterotomy was performed in a standard manner. Endoscopic papillary balloon dilatation was carried out with gradual inflation of a 4-, 6-, or 8-mm diameter balloon.
Complete duct clearance was achieved in 100% in the endoscopic sphincterotomy group and 99.3% in the endoscopic papillary balloon dilatation group (not significant). Complications occurred in 11.8% of patients in the endoscopic sphincterotomy group and 14.5% of those in the endoscopic papillary balloon dilatation group (not significant). No complication was severe; there was no mortality. The frequency of acute pancreatitis was higher in the endoscopic papillary balloon dilatation group than the endoscopic sphincterotomy group (respectively, 10.9% vs. 2.8%; p < 0.045). Hemorrhage occurred only in the endoscopic sphincterotomy group.
Endoscopic sphincterotomy and endoscopic papillary balloon dilatation were approximately equal in terms of successful clearance of bile duct stones. They were also similar with respect to overall complications. Endoscopic papillary balloon dilatation is an alternative to endoscopic sphincterotomy as a treatment of bile duct stones.
在胆管结石的治疗中，内镜下乳头球囊扩张术可能是内镜下括约肌切开术的一种替代方法。然而，关于内镜下乳头球囊扩张术的有效性和安全性存在争议。
纳入282例胆管结石患者，随机分为内镜下括约肌切开术组或内镜下乳头球囊扩张术组。前瞻性评估胆管清除成功率以及并发症的发生率和类型。内镜下括约肌切开术采用标准方式进行。内镜下乳头球囊扩张术通过逐渐充盈直径为4、6或8毫米的球囊来实施。
内镜下括约肌切开术组胆管完全清除率为100%，内镜下乳头球囊扩张术组为99.3%（无显著差异）。内镜下括约肌切开术组11.8%的患者发生并发症，内镜下乳头球囊扩张术组为14.5%（无显著差异）。无严重并发症；无死亡病例。内镜下乳头球囊扩张术组急性胰腺炎的发生率高于内镜下括约肌切开术组（分别为10.9%对2.8%；p<0.045）。出血仅发生在内镜下括约肌切开术组。
内镜下括约肌切开术和内镜下乳头球囊扩张术在胆管结石清除成功率方面大致相当。在总体并发症方面也相似。内镜下乳头球囊扩张术可作为内镜下括约肌切开术治疗胆管结石的一种替代方法。
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