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Endoscopic papillary balloon dilation for bile duct stone removal in patients 60 years old or younger
Takeshi Tsujino1, Haruhiko Yoshida, Hiroyuki Isayama
1Department of Gastroenterology, Faculty of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, Japan. tsujinot-int@h.u-tokyo.ac.jp
Insights
Endoscopic papillary balloon dilation (EPBD) effectively removes bile duct stones in younger patients. Cholecystectomy after EPBD is associated with the lowest stone recurrence risk, indicating favorable long-term outcomes.
Area of Science:
- Gastroenterology
- Endoscopic procedures
- Biliary tract interventions
Background:
- Endoscopic papillary balloon dilation (EPBD) is a common procedure for bile duct stone removal.
- Younger patients (≤ 60 years) undergoing EPBD require specific evaluation of short- and long-term outcomes.
- Gallbladder status significantly influences recurrence rates after EPBD.
Purpose of the Study:
- To assess the efficacy and safety of EPBD in patients aged 60 years or younger.
- To compare stone recurrence rates based on gallbladder status post-EPBD.
- To evaluate short-term complications, particularly pancreatitis, and long-term outcomes.
Main Methods:
- Retrospective analysis of 311 patients (≤ 60 years) undergoing EPBD for bile duct stones.
- Stratification of patients into four groups based on gallbladder status and cholecystectomy timing.
- Comparison of immediate outcomes (stone clearance, pancreatitis) and long-term outcomes (stone recurrence) over a mean follow-up of 5.6 years.
Main Results:
- Successful bile duct stone removal in 97.7% of patients via EPBD.
- Post-EPBD pancreatitis occurred in 7.7% of younger patients, higher than in older patients (4.7%).
- Cumulative stone recurrence rates at 5 and 10 years were 5.9% and 7.1%, respectively. Cholecystectomy after EPBD showed the lowest recurrence (2.0%).
Conclusions:
- EPBD is effective for bile duct stone removal in younger patients with a low risk of severe pancreatitis.
- Younger patients have a higher incidence of post-EPBD pancreatitis compared to older individuals.
- Favorable long-term outcomes are observed, particularly for patients who undergo cholecystectomy after EPBD.
Background:
The aim of this study was to evaluate short- and long-term outcomes in relatively young patients (≤ 60 years old) who underwent endoscopic papillary balloon dilation (EPBD) for bile duct stone removal.
Methods:
Immediate and long-term outcomes were evaluated in 311 patients who were 60 years old or younger at the time of EPBD. The stone recurrence rate was compared among four groups stratified according to gallbladder (GB) status before and after EPBD (cholecystectomy after EPBD, GB left in situ with stones, GB left in situ without stones, and cholecystectomy before EPBD).
Results:
Bile duct stones were completely removed via EPBD alone in 304 patients (97.7%). Post-EPBD pancreatitis occurred in 24 patients (7.7%), and was mild in 18 patients, moderate in 5 patients, and severe in 1 patient. The rate of pancreatitis was significantly higher in these patients than in patients aged more than 60 years who underwent EPBD during the same study period (4.7%). Long-term outcomes were evaluated in 217 patients who were followed for at least 1 year after complete stone removal via EPBD. During a mean follow-up period of 5.6 years (range, 1.0-13.4 years), stone recurrence was observed in 13 patients (6.0%). The cumulative stone recurrence rates at 5 and 10 years after EPBD were 5.9 and 7.1%, respectively. Patients in the cholecystectomy after EPBD group had the lowest risk of stone recurrence among the four groups (2.0%).
Conclusion:
EPBD removes bile duct stones in the majority of younger patients without increasing the risk of severe pancreatitis. Post-EPBD pancreatitis is more likely to occur in younger patients as compared to older patients. The long-term outcomes of EPBD appear favorable, especially in patients who have undergone cholecystectomy after EPBD.
