Which Is the Better Treatment for the Removal of Large Biliary Stones? Endoscopic Papillary Large Balloon Dilation versus Endoscopic Sphincterotomy

• Published in: Gut and liver 2014-07, Vol.8 (4), p.438
• Main Authors: Woo Hyun Paik, Ji Kon Ryu, Jin Myung Park, Byeong Jun Song, Jaihwan Kim, Joo Kyung Park, Yong Tae Kim
• Format: Article
• Language: Korean
• Subjects: Choledocholithiasis; endoscopic; Endoscopic papillary large balloon dilation; Mechanical lithotripsy; Sphincterotomy
• ISSN: 1976-2283

Background/Aims: We evaluated the efficacy and cost effectiveness of endoscopic papillary large balloon dilation(EPLBD) for large common bile duct (CBD) stone removal compared with endoscopic sphincterotomy (EST). Methods: A total of 1,580 patients who underwent endoscopic CBD stone extraction between January 2001 and July 2010 were reviewed. The following inclusion criteria were applied: choledocholithiasistreated by EPLBD with minor EST or EST with mechanical lithotripsy; and follow-up >9 months after treatment. Results: Forty-nine patients with EPLBD and 41 with EST were compared. There was no significant difference inthe complication rates and stone recurrence rates between the two groups. However, significantly more endoscopic retrograde cholangiopancreatography (ERCP) sessions were required in the EST group to achieve the complete removal of stones (1.7 times vs 1.3 times; p=0.03). The mean costre quired for complete stone removal per patient was significantly higher in the EST group compared to the EPLBD group(USD $1,644 vs $1,225, respectively; p=0.04). Dilated CBD was the only significant factor associated with recurrentbiliary stones (relative risk, 1.09; 95% confidence interval, 1.02 to 1.17; p=0.02). Conclusions: EPLBD is the better treatment (compared to EST) for removing large CBD stones because EPLBD requires fewer ERCP sessions and is lessexpensive