Small sphincterotomy combined with endoscopic papillary large balloon dilation versus sphincterotomy

Area of Science:

• Gastroenterology
• Endoscopic procedures
• Biliary tract diseases

Background:

• Large bile duct stones pose a significant clinical challenge.
• Endoscopic sphincterotomy (EST) is a common treatment, but large stones may require adjuncts.
• Small sphincterotomy combined with endoscopic papillary large balloon dilation (SES + ELBD) is an alternative approach.

Purpose of the Study:

• To compare the efficacy of SES + ELBD versus conventional EST for treating large bile duct stones (≥ 15 mm).

Main Methods:

• A prospective study comparing SES + ELBD (n=27) with conventional EST (n=28).
• Mechanical lithotripsy was used if stones were not removed with a standard basket.
• Key outcomes included rates of complete stone removal in one session and the need for mechanical lithotripsy.

Main Results:

• No significant differences were found in stone size, bile duct diameter, stone number, or procedure time between groups.
• Complete stone removal in one session was achieved in 85% of SES + ELBD patients and 86% of EST patients (P=0.473).
• Mechanical lithotripsy was required in 33% of SES + ELBD patients and 32% of EST patients (P=0.527).

Conclusions:

• SES + ELBD offers no significant advantage over conventional EST for large bile duct stone removal.
• Both techniques show comparable success rates and requirements for adjunctive lithotripsy.