Department of Gastroenterology, Athens Naval Hospital, and Second Academic Department of Internal Medicine, University of Athens, Medical School, Athens, Greece.
Am J Gastroenterol. 2011 Feb;106(2):278-85. doi: 10.1038/ajg.2010.421. Epub 2010 Nov 2.
The removal of large bile duct stones (>12 mm) after endoscopic sphincterotomy (EST) remains a challenging issue in therapeutic endoscopy. The aim of this prospective, randomized, controlled trial was to compare the effectiveness and complications of EST followed by large balloon dilation (LBD) with that of EST followed by mechanical lithotripsy (ML) for the management of large bile duct stones.
A total of 90 patients with large bile duct stones (12-20 mm) were randomized to EST followed by LBD (n=45) or EST followed by ML (n=45). Success rate was determined with a final cholangiogram, whereas type and rate of post-procedure complications were assessed prospectively.
Complete bile duct stone removal was accomplished in 97.7% of patients subjected to EST-LBD as compared with 91.1% of those subjected to EST-ML (P=0.36). Post-procedure complications were observed in two (4.4%) patients subjected to EST-LBD and in nine (20%) patients subjected to EST-ML (P=0.049). Rates of pancreatitis were similar between the two groups (one case in each), as was post-endoscopic retrograde cholangio pancreatography (ERCP) hemorrhage (one case in each group). None of the patients subjected to EST-LBD developed cholangitis, while this was seen in six patients subjected to EST-ML (0.0 vs. 13.3%, P=0.026). One patient subjected to EST-ML developed perforation, which was successfully managed conservatively. None of our patients with complications died.
EST followed by LBD is equally effective as EST followed by ML for the removal of large bile duct stones, although it is associated with fewer complications.
内镜下括约肌切开术（EST）后清除大的胆管结石（>12mm）仍然是治疗内镜学中的一个具有挑战性的问题。本前瞻性、随机、对照试验的目的是比较 EST 后大球囊扩张（LBD）与 EST 后机械碎石术（ML）治疗大胆管结石的疗效和并发症。
将 90 例大胆管结石（12-20mm）患者随机分为 EST 后行 LBD（n=45）或 EST 后行 ML（n=45）。通过最终的胆管造影确定成功率，前瞻性评估术后并发症的类型和发生率。
EST-LBD 组 97.7%的患者胆管结石完全清除，EST-ML 组 91.1%的患者胆管结石完全清除（P=0.36）。EST-LBD 组有 2 例（4.4%）和 EST-ML 组有 9 例（20%）患者出现术后并发症（P=0.049）。两组胰腺炎发生率相似（各 1 例），EST 后逆行胰胆管造影（ERCP）后出血也相似（各 1 例）。EST-LBD 组无一例发生胆管炎，而 EST-ML 组有 6 例（0.0 比 13.3%，P=0.026）。1 例 EST-ML 患者发生穿孔，保守治疗成功。我们所有的并发症患者均未死亡。
EST 后行 LBD 与 EST 后行 ML 清除大的胆管结石同样有效，但并发症较少。
