Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
Department of Gastroenterology, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
Dig Endosc. 2019 Jan;31(1):59-68. doi: 10.1111/den.13220. Epub 2018 Jul 26.
Endoscopic papillary large balloon dilation (EPLBD) without endoscopic sphincterotomy (EST) may facilitate extraction of large bile duct stones through achieving adequate dilation of the ampulla. However, contrary to favorable long-term outcomes after endoscopic papillary balloon dilation (EPBD), that of EPLBD without EST has been little investigated. Therefore, we conducted the current study to evaluate short- and long-term outcomes of EPLBD without EST and EPBD after removal of large bile duct stones (LBDS; ≥10 mm).
This retrospective study included patients without a previous history of EST, EPBD or EPLBD who underwent EPLBD without EST or EPBD for removal of LBDS. Each patient in the EPLBD without EST group was matched to a patient in the EPBD group using propensity scores.
Forty-four patients in each group were matched for the analysis. Baseline characteristics were balanced after propensity matching. Rate of complete stone removal in a single session was higher (80% vs 16%, P < 0.001), number of ERCP sessions (1.3 ± 0.7 vs 2.4 ± 1.5, P < 0.001) and rate of lithotripsy use (30% vs 80%, P < 0.001) were smaller in the matched EPLBD without EST group. Contrary to null between-group differences in early adverse events (P = 0.99), a cumulative rate of late biliary complications was higher in the EPLBD without EST group (P = 0.02).
EPLBD without EST showed higher efficacy for removal of LBDS but was associated with worse long-term outcomes when compared to EPBD.
内镜下乳头大球囊扩张（EPLBD）而不进行内镜下括约肌切开术（EST）可能通过充分扩张乳头来促进大胆管结石的取出。然而，与内镜下乳头球囊扩张（EPBD）后的有利长期结果相反，EPLBD 而不进行 EST 的结果尚未得到充分研究。因此，我们进行了这项研究，以评估 EPLBD 而不进行 EST 和 EPBD 治疗大胆管结石（LBDS；≥10mm）后的短期和长期结果。
这项回顾性研究纳入了既往无 EST、EPBD 或 EPLBD 史的患者，这些患者接受 EPLBD 而不进行 EST 或 EPBD 以取出 LBDS。EPLBD 而不进行 EST 组中的每位患者均与 EPBD 组中的一位患者进行了倾向评分匹配。
每组有 44 例患者进行了匹配分析。倾向评分匹配后，基线特征平衡。单次治疗完全取石率更高（80%比 16%，P＜0.001），ERCP 次数（1.3±0.7 次比 2.4±1.5 次，P＜0.001）和碎石使用率（30%比 80%，P＜0.001）较小。与两组之间早期不良事件无差异（P=0.99）相反，EPLBD 而不进行 EST 组的晚期胆道并发症累积发生率更高（P=0.02）。
EPLBD 而不进行 EST 治疗 LBDS 的效果更高，但与 EPBD 相比，长期结果更差。
