Oh Myung Jin, Kim Tae Nyeun
Division of Gastroenterology and Hepatology, Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, Korea.
Scand J Gastroenterol. 2012 Sep;47(8-9):1071-7. doi: 10.3109/00365521.2012.690046.
Although endoscopic papillary large balloon dilation (EPLBD) with limited endoscopic sphincterotomy (ES) showed excellent outcomes for treatment of large bile duct stones, hemorrhage and recurrence of stones are problematic complications. Recent studies suggest that EPLBD alone is safe and effective for removal of large bile duct stones. This study aimed to determine the therapeutic outcomes and safety of EPLBD, compared with ES, for removal of large bile duct stones.
Eighty-three patients above 45 years of age with bile duct stones >1 cm in diameter were randomized to EPLBD and ES groups for removal of common bile duct stones from September 2010 to August 2011. Prophylactic gabexate mesilate was given to all patients.
Baseline characteristics were not significantly different, except diabetes and gallbladder stones between the EPLBD group (n = 40) and ES group (n = 43). The overall complete stone removal rate in each group was 97.5% (39/40) and 95.3% (41/43), respectively (p = 0.600). Requirement of mechanical lithotripsy was not significantly different between the EPLBD and ES group (10% vs. 21%, p = 0.171). Complete ductal clearance in one session was achieved in 82.4% and 81.4% of cases in each group, respectively (p = 0.577). There were no differences in complication rates between the EPLBD and ES group; pancreatitis, 5.0% vs. 7.0%; hemorrhage, 10.0% vs. 16.3%; acute cholangitis, 5.0% vs. 2.3%, and perforation, 2.5% vs. 0%.
The therapeutic outcomes and complications of EPLBD for removal of large bile duct stones are comparable to those of ES.
尽管内镜乳头大球囊扩张术（EPLBD）联合有限的内镜括约肌切开术（ES）在治疗胆总管结石方面显示出良好的效果，但出血和结石复发是棘手的并发症。近期研究表明，单纯EPLBD对于去除胆总管结石是安全有效的。本研究旨在确定与ES相比，EPLBD去除胆总管结石的治疗效果和安全性。
2010年9月至2011年8月，将83例年龄在45岁以上、胆管结石直径>1 cm的患者随机分为EPLBD组和ES组，以去除胆总管结石。所有患者均给予预防性甲磺酸加贝酯。
EPLBD组（n = 40）和ES组（n = 43）之间，除糖尿病和胆囊结石外，基线特征无显著差异。每组的总体结石完全清除率分别为97.5%（39/40）和95.3%（41/43）（p = 0.600）。EPLBD组和ES组之间机械碎石术的需求无显著差异（10%对21%，p = 0.171）。每组分别有82.4%和81.4%的病例在一次手术中实现了胆管完全清除（p = 0.577）。EPLBD组和ES组之间的并发症发生率无差异；胰腺炎，5.0%对7.0%；出血，10.0%对16.3%；急性胆管炎，5.0%对2.3%，穿孔，2.5%对0%。
EPLBD去除胆总管结石的治疗效果和并发症与ES相当。
