Endoscopic sphincterotomy combined with large balloon dilation for removal of large bile duct stones

Recently, there have been sporadic reports of lithotomy using endoscopic sphincterotomy combined with large balloon dilation (EPLBD) against large or multiple bile duct stones. However, there are not many reports so far concerning this procedure. Therefore, we decided to discuss the results of EPLBD against large or multiple bile duct stones.

Stone retrieval using EPLBD was performed with 59 patients of choledocholithiasis, A) with 13 mm or more in shortest dimension, or B) multiple (≥3) bile duct stones, with the smallest more than 10 mm in shortest dimension. The papilla treated with endoscopic sphincterotomy (EST) was dilated using a 12-20 mm balloon suitable for the biliary ductal size.

The success rate for the first lithotomy for choledocholithiasis was 83.1% (49/59). The final lithotomy rate was 100% (59/59). The time required for lithotomy was 43.7 (12-125) minutes and the number of treatment was 1.3 (1-4) on average. Lithotripsy was needed in 13.6% (8/59). The incidence of coincidental events associated with the procedure was 6.8% (4/59). No pancreatitis was noted.

An endoscopic treatment using EST plus large balloon dilation against large or multiple bile duct stones was suggested to be safe and effective.