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Endoscopic Papillary Large Balloon Dilation Reduces Further Recurrence in Patients With Recurrent Common Bile Duct
Xu Wang1, Xiangping Wang1, Hao Sun2
1State Key Laboratory of Cancer Biology, National Clinical Research Center for Digestive Diseases and Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, Shaanxi, China.
The American Journal of Gastroenterology
|February 22, 2022
Summary
Endoscopic papillary large balloon dilation (EPLBD) significantly reduces common bile duct stone (CBDS) recurrence after ERCP. This method offers a more effective approach to managing recurrent CBDS compared to traditional ERCP alone.
Area of Science:
- Gastroenterology
- Endoscopic procedures
- Biliary tract diseases
Background:
- Recurrent common bile duct stones (CBDS) affect up to 60% of patients post-ERCP.
- Effective prevention strategies for CBDS recurrence are lacking.
- Endoscopic retrograde cholangiopancreatography (ERCP) is a common treatment for CBDS.
Purpose of the Study:
- To evaluate the short-term and long-term efficacy of endoscopic papillary large balloon dilation (EPLBD) in preventing CBDS recurrence.
- To compare EPLBD with conventional ERCP in patients with recurrent CBDS.
- To assess the impact of EPLBD on the rate of complete stone clearance in a single ERCP session.
Main Methods:
- A randomized controlled trial involving 180 patients with recurrent CBDS.
- Patients were assigned 1:1 to EPLBD or a control group (conventional ERCP).
- Primary outcome was CBDS recurrence rate within 2 years; intention-to-treat analysis was used.
Main Results:
- EPLBD resulted in a significantly higher rate of complete CBDS clearance in one session (95.6% vs 85.6%).
- The 2-year CBDS recurrence rate was significantly lower in the EPLBD group (21.1% vs 36.7%).
- Long-term follow-up showed reduced recurrence (34.4% vs 51.1%) and fewer multiple recurrences (4.4% vs 18.9%) with EPLBD.
Conclusions:
- Endoscopic papillary large balloon dilation (EPLBD) is an effective method for reducing the recurrence of common bile duct stones.
- EPLBD improves the success rate of stone clearance in a single ERCP session.
- This study provides the first evidence that EPLBD can significantly decrease long-term CBDS recurrence.
