Tsuchida Kouhei, Iwasaki Mari, Tsubouchi Misako, Suzuki Tsunehiro, Tsuchida Chieko, Yoshitake Naoto, Sasai Takako, Hiraishi Hideyuki
Department of Gastroenterology, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Shimotsuga, Tochigi, 321-0293, Japan.
BMC Gastroenterol. 2015 May 16;15:59. doi: 10.1186/s12876-015-0290-6.
Endoscopic sphincterotomy (EST) is currently recognized as the primary endoscopic treatment for common bile duct stones. However, it is difficult to remove multiple (≥ 3) or large (≥ 15 mm) common bile duct stones with EST alone. Recently, EST plus endoscopic papillary large-balloon dilation (EPLBD) was reported to be an effective treatment for such bile duct stones. We compared the results of EST and EST + EPLBD for multiple (≥ 3) or large (≥ 15 mm) stones that were difficult to treat using EST alone. We also compared the complication rates between the techniques.
Seventy patients with large (largest diameter, ≥ 15 mm) or ≥ 3 common bile duct stones treated in our department between April 2010 and March 2013 underwent EST + EPLBD (n = 34) or EST alone (n = 36). We compared final successful stone removal rates, rates of successful stone removal in the first session, procedure times, status of concurrent mechanical lithotripsy (ML), and complications between the EST + EPLBD and EST groups.
The rates of final successful stone removal were similar between the two groups (EST + EPLBD: 100 % vs. EST: 89 %; p = 0.115). The rate of successful stone removal in the first session was significantly higher in the EST + EPLBD group (EST + EPLBD: 88 % vs. EST: 56 %; p = 0.03). Moreover, the procedure time was significantly shorter (EST + EPLBD: 42 min vs. EST: 67 min; p = 0.011) and the rate of ML use was significantly lower in the EST + EPLBD group (EST + EPLBD: 50 % vs. EST: 94 %; p < 0.001). Complications like pancreatitis and bleeding occurred in three patients in the EST + EPLBD group and in 10 patients in the EST group, but the differences were not statistically significant (EST + EPLBD: 9 % vs. EST: 25 %; p = 0.112).
Our results suggest that EST + EPLBD is an effective therapy for patients with difficult-to-treat multiple or large common bile duct stones, because it requires fewer sessions and shorter operative times than EST alone.
内镜括约肌切开术（EST）目前被认为是治疗胆总管结石的主要内镜治疗方法。然而，单独使用EST难以取出多发（≥3枚）或较大（≥15mm）的胆总管结石。最近，有报道称EST联合内镜乳头大球囊扩张术（EPLBD）是治疗此类胆管结石的有效方法。我们比较了EST和EST+EPLBD治疗单独使用EST难以治疗的多发（≥3枚）或较大（≥15mm）结石的效果。我们还比较了两种技术之间的并发症发生率。
2010年4月至2013年3月期间在我科接受治疗的70例患有较大（最大直径≥15mm）或≥3枚胆总管结石的患者接受了EST+EPLBD（n=34）或单独EST（n=36）治疗。我们比较了EST+EPLBD组和EST组的最终结石清除成功率、首次治疗的结石清除成功率、手术时间、同期机械碎石术（ML）的使用情况以及并发症。
两组的最终结石清除成功率相似（EST+EPLBD：100% vs. EST：89%；p=0.115）。EST+EPLBD组首次治疗的结石清除成功率显著更高（EST+EPLBD：88% vs. EST：56%；p=0.03）。此外，EST+EPLBD组的手术时间显著更短（EST+EPLBD：42分钟 vs. EST：67分钟；p=0.011），且ML使用率显著更低（EST+EPLBD：50% vs. EST：94%；p<0.001）。EST+EPLBD组有3例患者发生胰腺炎和出血并发症，EST组有10例患者发生，但差异无统计学意义（EST+EPLBD：9% vs. EST：25%；p=0.112）。
我们的结果表明，EST+EPLBD是治疗难以治疗的多发或较大胆总管结石患者的有效疗法，因为与单独使用EST相比，它所需的治疗次数更少，手术时间更短。
