Endoscopic Sphincterotomy With Balloon Dilatation Versus Sphincterotomy Alone For Common Bile Duct Stones Removal

Mostafa R Elkeleny, Mohamed M Kandel, Ahmed I Ellakany, Mohamed H Sultan, Islam El-Sayes


Introduction: Endoscopic sphincterotomy (EST) is now  known as the main endoscopic treatment of stone in common bile duct. However, it is difficult to extract multiple (3 or more) or large (≥10mm) common bile duct stones with EST. EST plus endoscopic large balloon papillary dilation (EPLBD) balloon was identified as a valid treatment option for these bile duct stones.

Aim of this work: to compare the EST alone versus EST plus EPBD regarding efficacy, feasibility, advantages, and complications.

Methods: Forty patients with large common bile duct stones (CBD) (≥ 10 mm) or multiple stones (≥ 3) underwent EST + EPLBD (20 cases) or EST alone (20 cases). We compared the stone removal rates in the first session, procedure times and complications recorded in both groups.

Results: The rates of stone extraction were comparable between the both groups (EST plus EPLBD: 95% versus EST: 90%). Regarding the procedure time a shorter procedure time was observed in EST plus EPLBD group (EST + EPLBD: 52 min versus EST: 54 min; p = 0.545). Complications like pancreatitis occurred in one case in the EST + EPLBD group and in two cases in the EST group, but without significance difference (EST + EPLBD: 5% vs. EST: 10%).

Conclusions: EST + EPLBD is safe and an effective method for treatment of the patients with either large or multiple CBD stones, as fewer sessions were required, and shorter operative times was observed than EST alone.


Endoscopic sphincterotomy (EST); EST plus endoscopic papillary large-balloon dilation (EPLBD); Post ERCP pancreatitis

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