Jun Baek Gyu, Lee Tae Hoon, Jeong Seok, Hwang Jae Chul, Yang Min Jae, Song Tae Jun, Choi Hyun Jong, Moon Jong Ho, Park Sang-Heum
Digestive Disease Center, Department of Internal Medicine, Soonchunhyang University School of Medicine, Cheonan and Bucheon, South Korea.
J Gastroenterol Hepatol. 2014;29(7):1551-6. doi: 10.1111/jgh.12564.
After selective biliary access following precut fistulotomy in difficult biliary cannulations (DBC), there are several methods of completely opening the remaining papillary roof for the removal of biliary stones. We evaluated the efficacy of one-step transfistula balloon dilation following fistulotomy in DBC for the removal of biliary stones.
This retrospective multicenter study was performed in four tertiary referral centers. Patients who underwent fistulotomy due to DBC were enrolled. Precut fistulotomy followed by conventional (≤ 10 mm) or large balloon (≥ 12 mm) dilation through the fistulotomy tract was performed to remove biliary stones. The main outcome measures were technical success and transfistula balloon dilation-related complications.
A total of 154 patients were enrolled. Large balloon and conventional balloon dilation were performed in 57 and 97 patients, respectively. The primary technical success of stone removal was 100% (57/57) for large balloon dilation and 96.9% (94/97) for conventional balloon dilation (P = 0.296). The mean procedure time from biliary access to removal of stones was 29.3 min in large balloon and 22.2 min in conventional balloon dilation (P = 0.042), and the mean numbers of endoscopic retrograde cholangiopancreatography sessions were 1.4 and 1.3, respectively (P = 0.175). Transfistula balloon dilation-related complications were not different between the two groups (10.5% in large balloon dilation vs 16.5% in conventional balloon dilation, P = 0.307).
One-step transfistula balloon dilation following precut fistulotomy in DBC may be safe and effective for the removal of biliary stones. There were no differences in therapeutic outcomes and complications between large and conventional balloon dilation.
在困难胆管插管（DBC）行预切开瘘管切开术后进行选择性胆管通路建立后，有多种方法可完全打开剩余的乳头顶部以取出胆管结石。我们评估了DBC行瘘管切开术后一步经瘘管球囊扩张术在胆管结石取出中的疗效。
本回顾性多中心研究在四个三级转诊中心进行。纳入因DBC行瘘管切开术的患者。通过瘘管切开通道进行预切开瘘管切开术，随后进行常规（≤10mm）或大球囊（≥12mm）扩张以取出胆管结石。主要观察指标为技术成功率和经瘘管球囊扩张相关并发症。
共纳入154例患者。分别对57例和97例患者进行了大球囊和常规球囊扩张。大球囊扩张取石的主要技术成功率为100%（57/57），常规球囊扩张为96.9%（94/97）（P = 0.296）。从胆管通路建立到结石取出的平均手术时间，大球囊扩张为29.3分钟，常规球囊扩张为22.2分钟（P = 0.042），内镜逆行胰胆管造影术的平均次数分别为1.4次和1.3次（P = 0.175）。两组经瘘管球囊扩张相关并发症无差异（大球囊扩张组为10.5%，常规球囊扩张组为16.5%，P = 0.307）。
DBC行预切开瘘管切开术后一步经瘘管球囊扩张术在胆管结石取出中可能是安全有效的。大球囊扩张和常规球囊扩张在治疗效果和并发症方面无差异。
