Endoscopic sphincterotomy or papillary balloon dilatation for choledocholithiasis.

Area of Science:

• Gastroenterology
• Endoscopic procedures
• Biliary tract diseases

Background:

• Choledocholithiasis, the presence of gallstones in the common bile duct, is a common condition requiring intervention.
• Endoscopic retrograde cholangiopancreatography (ERCP) with associated interventions is a primary treatment modality.
• Assessing the comparative safety and efficacy of different endoscopic techniques is crucial for optimal patient management.

Purpose of the Study:

• To evaluate the safety and effectiveness of endoscopic sphincterotomy (EST) and endoscopic papillary balloon dilatation (EPBD) in treating choledocholithiasis.
• To compare the outcomes of EST and EPBD based on stone characteristics and patient factors.

Main Methods:

• A cohort of 328 patients diagnosed with choledocholithiasis underwent either EST or EPBD.
• Patient selection for EST (stones >11 mm) or EPBD (stones <10 mm) was based on stone size.
• Interventions included stone extraction via baskets, balloons, and lithotripsy when necessary.

Main Results:

• The combined success rate for EST and EPBD was high at 98.5% (323 out of 328 patients).
• Complications occurred in 2.5% of patients, including gastrointestinal hemorrhage (1), cholangitis (4), and pancreatitis (3).
• Spontaneous stone expulsion or successful extraction was achieved in the majority of patients, with minimal need for repeat procedures or advanced lithotripsy.

Conclusions:

• Endoscopic sphincterotomy and endoscopic papillary balloon dilatation are safe and effective therapeutic options for choledocholithiasis.
• Both procedures demonstrate a favorable safety profile with a low rate of significant complications.