Lin C K, Lai K H, Chan H H, Tsai W L, Wang E M, Wei M C, Fu M T, Lo C C, Hsu P I, Lo G H
Department of Internal Medicine, Kaohsiung Veterans General Hospital, School of Medicine, National Yang Ming University, 386 Ta-Chung 1st Road, Kaohsiung 813, Taiwan.
Dig Liver Dis. 2004 Jan;36(1):68-72. doi: 10.1016/j.dld.2003.09.014.
Endoscopic sphincterotomy is a widely accepted treatment for patients with common bile duct stones. Despite improvement in this technique, endoscopic sphincterotomy is still associated with some biliary complications. Endoscopic balloon dilatation is a less traumatic and sphincter preserving method for removal of common bile duct stones. However, the results of controlled studies in comparison with these two methods are contradictory. The aim of this study is to compare the safety and efficacy of endoscopic balloon dilatation and endoscopic sphincterotomy in Chinese patients.
A total of 104 patients with common bile duct stones on endoscopic retrograde cholangiopancreatography were enrolled. They were randomly assigned to endoscopic balloon dilatation or endoscopic sphincterotomy. Endoscopic balloon dilatation was performed by using a balloon dilator to dilate the sphincter for 5 min. The common bile duct stones were then removed by a Dormia basket after endoscopic balloon dilatation or endoscopic sphincterotomy. Mechanical lithotripsy was performed if the stones were difficult to remove by Dormia basket. After discharge, patients were regularly followed up for biliary complications.
The successful bile duct stone clearance rate was 94.1% in endoscopic balloon dilatation group and 100% in endoscopic sphincterotomy group. Post-procedural significant haemorrhage was higher in endoscopic sphincterotomy group than in endoscopic balloon dilatation group (14/53 versus 1/48, P < 0.001). The bleeding patient from endoscopic balloon dilatation group was a case of uremia and bleeding occurred 48 h after endoscopic balloon dilatation. All the patients with post-procedural haemorrhage were controlled endoscopically. The post-procedural serum amylase level showed no significant difference in both groups and none of them developed clinical pancreatitis. After a mean 16 months follow-up, three patients (6.3%) in endoscopic balloon dilatation group and four patients (7.5%) in endoscopic sphincterotomy group developed recurrent common bile duct stones. The recurrent common bile duct stones were multiple and muddy in consistency. They were successfully removed endoscopically.
Both endoscopic balloon dilatation and endoscopic sphincterotomy are safe and effective techniques for the treatment of common bile duct stones. Endoscopic balloon dilatation can be safely applied in patients with coagulopathy and does not increase the incidence of pancreatitis or bleeding.
内镜括约肌切开术是治疗胆总管结石患者广泛接受的一种方法。尽管该技术有所改进，但内镜括约肌切开术仍与一些胆道并发症相关。内镜球囊扩张术是一种创伤较小且保留括约肌的胆总管结石清除方法。然而，对比这两种方法的对照研究结果相互矛盾。本研究的目的是比较内镜球囊扩张术与内镜括约肌切开术在中国患者中的安全性和有效性。
共有104例经内镜逆行胰胆管造影显示胆总管结石的患者入组。他们被随机分配至内镜球囊扩张术组或内镜括约肌切开术组。内镜球囊扩张术通过使用球囊扩张器扩张括约肌5分钟来进行。然后在内镜球囊扩张术或内镜括约肌切开术后用多尔米亚网篮取出胆总管结石。如果结石难以用多尔米亚网篮取出，则进行机械碎石术。出院后，对患者进行胆道并发症的定期随访。
内镜球囊扩张术组胆总管结石成功清除率为94.1%，内镜括约肌切开术组为100%。内镜括约肌切开术组术后严重出血发生率高于内镜球囊扩张术组（14/53对比1/48，P<0.001）。内镜球囊扩张术组的出血患者为1例尿毒症患者，出血发生在内镜球囊扩张术后48小时。所有术后出血患者均通过内镜得到控制。术后血清淀粉酶水平在两组中无显著差异，且均未发生临床胰腺炎。经过平均16个月的随访，内镜球囊扩张术组有3例患者（6.
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