Endoscopic sphincter dilation in patients with bile duct stones: immediate and medium-term results

Endoscopic sphincter dilation (ESD) is believed to successfully treat bile duct stones without serious procedure-related complications.

We evaluated the efficacy, safety and limitations of this relatively new procedure in a consecutive series of patients to establish the clinical role of this modality for treating bile duct stones. One hundred and forty-three consecutive patients were treated by ESD between July 1995 and March 1998. The balloons used were a Maxforce 5-Fr or Olbert 5-Fr balloon-tipped catheter with a maximal diameter of 8 mm. Mechanical lithotriptor (ML) or extracorporeal shock wave lithotripsy (ESWL) were used when stones were large and/or numerous and a Dormia basket or retrievable balloon catheter was used to extract the stones entirely. Procedure-related symptoms and chemical data after the procedure were monitored during and after ESD at least until the following morning. To diagnose residual stones accurately, intraductal ultrasonography was routinely used.

Although the majority of patients complained of subtle pain during balloon inflation and demonstrated oozing during and after balloon inflation, the procedures were well tolerated. Complete stone extraction was achieved in 139 (97.2%) of the patients. Mechanical lithotriptor and ESWL were used to assist stone clearance in 79 (55.2%) and 23 (16.1%) patients, respectively. Mild pancreatitis occurred in six patients (4.2%). However, there were no other serious complications. Stone recurrence was identified in six patients and these stones were re-extracted by subsequent ESD procedures.

A high success rate for stone extraction and the relative safety of this procedure was confirmed. However, there was recurrence in a relatively high percentage of patients within a short period and this may be a forthcoming issue in ESD. Long-term follow-up observation and the establishment of countermeasures for stone recurrence seem to be essential.