Grande Giuseppe, Cocca Silvia, Bertani Helga, Caruso Angelo, Pigo' Flavia, Mangiafico Santi, Russo Salvatore, Lupo Marinella, Masciangelo Graziella, Cantu' Paolo, Manta Raffaele, Conigliaro Rita
Gastroenterology and Digestive Endoscopy Unit, Azienda Ospedaliero Universitaria di Modena, Modena 41126, Italy.
Gastroenterology and Endoscopy Unit, Department of Pathophysiology and Transplantation, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico and Università degli Studi di Milano, Milano 20122, Italy.
World J Gastrointest Endosc. 2021 Feb 16;13(2):33-44. doi: 10.4253/wjge.v13.i2.33.
Common bile duct stones are frequently diagnosed worldwide and are one of the main indications for endoscopic retrograde cholangio-pancreatography. Endoscopic sphincterotomy (EST) has been used for the removal of bile duct stones for the past 40 years, providing a wide opening to allow extraction. Up to 15% of patients present with complicated choledocholithiasis. In this context, additional therapeutic approaches have been proposed such as endoscopic mechanical lithotripsy, intraductal or extracorporeal lithotripsy, or endoscopic papillary large balloon dilation (EPLBD). EPLBD combined with EST was introduced in 2003 to facilitate the passage of large or multiple bile duct stones using a balloon greater than 12 mm in diameter. EPLBD without EST was introduced as a simplified technique in 2009. Dilation-assisted stone extraction (DASE) is the combination of two techniques: EPLBD and sub-maximal EST. Several studies have reported this technique as safe and effective in patients with large bile duct stones, without any increased risk of adverse events such as pancreatitis, bleeding, or perforation. Nevertheless, it is difficult to analyze the outcomes of DASE because there are no standard techniques and definitions between studies. The purpose of this paper is to provide technical guidance and specific information about the main issues regarding DASE, based on current literature and daily clinical experience in biliary referral centers.
胆总管结石在全球范围内经常被诊断出来，是内镜逆行胰胆管造影的主要指征之一。在过去40年里，内镜括约肌切开术（EST）一直被用于去除胆管结石，它提供了一个宽大的开口以便取出结石。高达15%的患者患有复杂性胆总管结石。在这种情况下，人们提出了其他治疗方法，如内镜机械碎石术、导管内或体外碎石术，或内镜乳头大球囊扩张术（EPLBD）。EPLBD联合EST于2003年被引入，以使用直径大于12毫米的球囊促进大的或多发胆管结石的通过。无EST的EPLBD于2009年作为一种简化技术被引入。扩张辅助结石取出术（DASE）是两种技术的结合：EPLBD和次最大EST。几项研究报告称，该技术在患有大胆管结石的患者中是安全有效的，不会增加胰腺炎、出血或穿孔等不良事件的风险。然而，由于各研究之间没有标准技术和定义，因此很难分析DASE的结果。本文的目的是根据当前文献和胆道转诊中心的日常临床经验，提供有关DASE主要问题的技术指导和具体信息。
