Komatsu Y, Kawabe T, Toda N, Ohashi M, Isayama M, Tateishi K, Sato S, Koike Y, Yamagata M, Tada M, Shiratori Y, Yamada H, Ihori M, Kawase T, Omata M
Second Department of Internal Medicine, Faculty of Medicine, University of Tokyo, Japan.
Endoscopy. 1998 Jan;30(1):12-7. doi: 10.1055/s-2007-993721.
Endoscopic sphincterotomy is a widely accepted technique for the treatment of patients with common bile duct stones. However, it is still associated with occasional complications. The recently developed technique of endoscopic papillary balloon dilation seems to be a safe and effective procedure, and to have great potential for replacing endoscopic sphincterotomy. However, few reports have been published on the use of this technique for bile duct stones. The present study was undertaken to evaluate its safety and efficacy.
Endoscopic papillary balloon dilation was used to remove common bile duct stones in 226 consecutive patients including 41 patients of ASA classification III/IV, 41 elderly patients (> 80 years) 24 with liver cirrhosis, and 86 with periampullary diverticulum. After dilation of the papilla with a balloon diameter of 8 mm, the stones were retrieved.
In conjunction with the use of a mechanical or/and electrohydraulic lithotriptor in 79 patients (35%) with large stones (> 10 mm in diameter), clearance of the common bile duct was achieved in 225 of 226 patients (99%) without serious complications, such as hemorrhage or severe pancreatitis; mild (n = 13) or moderate (n = 2) pancreatitis occurred in 7% of cases.
Endoscopic papillary balloon dilation is a safe and effective technique for the treatment of common bile duct stones, even in high-risk patients.
内镜括约肌切开术是治疗胆总管结石患者广泛接受的技术。然而，它仍偶尔伴有并发症。最近开发的内镜乳头球囊扩张技术似乎是一种安全有效的手术方法，并且有很大潜力取代内镜括约肌切开术。然而，关于该技术用于胆管结石的报道很少。本研究旨在评估其安全性和有效性。
对连续226例患者采用内镜乳头球囊扩张术清除胆总管结石，其中包括41例ASA分级为III/IV级的患者、41例老年患者（>80岁）、24例肝硬化患者和86例壶腹周围憩室患者。用直径8mm的球囊扩张乳头后，取出结石。
79例（35%）直径>10mm的大结石患者联合使用机械或/和液电碎石器，226例患者中有225例（99%）实现胆总管结石清除，无出血或重症胰腺炎等严重并发症；7%的病例发生轻度（n = 13）或中度（n = 2）胰腺炎。
内镜乳头球囊扩张术是治疗胆总管结石的一种安全有效的技术，即使在高危患者中也是如此。
