Guo Shi-Bin, Meng Hua, Duan Zhi-Jun, Li Chun-Yan
Shi-Bin Guo, Department of Gastroenterological Endoscopy, the First Affiliated Hospital of Dalian Medical University, Dalian 116011, Liaoning Province, China.
World J Gastroenterol. 2014 Dec 21;20(47):17962-9. doi: 10.3748/wjg.v20.i47.17962.
To evaluate the efficacy and safety of endoscopic papillary large diameter balloon dilation (EPLBD) following limited endoscopic sphincterotomy (EST) and EST alone for removal of large common bile duct (CBD) stones.
We retrospectively compared EST + EPLBD (group A, n = 64) with EST alone (group B, n = 89) for the treatment of large or multiple bile duct stones. The success rate of stone clearance, procedure-related complications and incidents, frequency of mechanical lithotripsy use, and recurrent stones were recorded.
There was no statistically significant difference between the two groups regarding periampullary diverticula (35.9% vs 34.8%, P > 0.05), pre-cut sphincterotomy (6.3% vs 6.7%, P > 0.05), size (12.1 ± 2.0 mm vs 12.9 ± 2.6 mm, P > 0.05) and number (2.2 ± 1.9 vs 2.4 ± 2.1, P > 0.05) of stones or the diameters of CBD (15.1 ± 3.3 mm vs 15.4 ± 3.6 mm, P > 0.05). The rates of overall stone removal and stone removal in the first session were not significantly different between the two groups [62/64 (96.9%) vs 84/89 (94.4%), P > 0.05; and 58/64 (90.6%) vs 79/89 (88.8%), P > 0.05, respectively]. The rates of post-endoscopic retrograde cholangiopancreatography pancreatitis and hyperamylasemia were not significantly different between the two groups [3/64 (4.7%) vs 4/89 (4.5%), P > 0.05; 7/64 (10.9%) vs 9/89 (10.1%), P > 0.05, respectively]. There were no cases of perforation, acute cholangitis, or cholecystitis in the two groups. The rate of bleeding and the recurrence of CBD stones were significantly lower in group A than in group B [1/64 (1.6%) vs 5/89 (5.6%), P < 0.05; 1/64 (1.6%) vs 6/89 (6.7%), P < 0.05, respectively].
EST + EPLBD is an effective and safe endoscopic approach for removing large or multiple CBD stones.
评估有限内镜括约肌切开术（EST）后行内镜乳头大直径球囊扩张术（EPLBD）以及单纯EST治疗胆总管（CBD）大结石的疗效和安全性。
我们回顾性比较了EST + EPLBD组（A组，n = 64）和单纯EST组（B组，n = 89）治疗大的或多发胆管结石的情况。记录结石清除成功率、与手术相关的并发症和事件、机械碎石术的使用频率以及复发性结石情况。
两组在壶腹周围憩室（35.9%对34.8%，P > 0.05）、预切开括约肌切开术（6.3%对6.7%，P > 0.05）、结石大小（12.1±2.0mm对12.9±2.6mm，P > 0.05）、结石数量（2.2±1.9对2.4±2.1，P > 0.05）或胆总管直径（15.1±3.3mm对15.4±3.6mm，P > 0.05）方面无统计学显著差异。两组的总体结石清除率和首次手术结石清除率无显著差异[62/64（96.9%）对84/89（94.4%），P > 0.05；以及58/64（90.6%）对79/89（88.8%），P > 0.05]。两组内镜逆行胰胆管造影术后胰腺炎和高淀粉酶血症的发生率无显著差异[3/64（4.7%）对4/89（4.5%），P > 0.05；7/64（10.9%）对9/89（10.1%），P > 0.05]。两组均无穿孔、急性胆管炎或胆囊炎病例。A组的出血率和胆总管结石复发率显著低于B组[1/64（1.6%）对5/89（5.6%），P < 0.05；1/64（1.6%）对6/89（6.7%），P < 0.05]。
EST + EPLBD是一种有效且安全的内镜方法，用于清除大的或多发的CBD结石。
