Complex biliary stones management: cholangioscopy versus papillary large balloon dilation - a randomized controlled...

Area of Science:

• Gastroenterology
• Endoscopic procedures
• Biliary interventions

Background:

• Endoscopic stone removal has high success rates, but challenging stones require advanced techniques.
• Papillary large balloon dilation and cholangioscopy-guided lithotripsy are established methods.
• No direct comparison existed between these two techniques for complex biliary stones.

Purpose of the Study:

• To compare the efficacy and safety of cholangioscopy-guided electrohydraulic lithotripsy versus endoscopic papillary large balloon dilation for complex biliary stone removal.
• To evaluate the non-inferiority of cholangioscopy-guided lithotripsy compared to large balloon dilation.

Main Methods:

• A randomized non-inferiority trial involving 100 patients with complex biliary stones.
• Group 1: Cholangioscopy with electrohydraulic lithotripsy. Group 2: Endoscopic papillary large balloon dilation.
• Primary outcome: complete stone removal. Secondary outcomes: procedure time, adverse events, and success after a second session if needed.

Main Results:

• Initial complete stone removal rates were similar: 77.1% for cholangioscopy and 72% for balloon dilation (P > 0.05).
• Overall success reached 90.1% after a second session, with no significant difference between groups.
• Procedure time was significantly shorter for large balloon dilation (-25.2 min). No significant differences in technical success, radiation exposure, or adverse events.

Conclusions:

• Single-operator cholangioscopy-guided lithotripsy and endoscopic papillary large balloon dilation are safe and effective for complex biliary stone removal.
• Both techniques offer comparable success rates for challenging biliary stones.
• Large balloon dilation may offer a shorter procedure time.