Endoscopic sphincterotomy with balloon dilation vs. monotherapy for choledocholithiasis in periampullary...

Periampullary diverticulum (PAD) often increases the difficulty of ERCP operation, and there is no standardized treatment strategy. This study compared the efficacy of "small incision + large balloon dilation (EST + EPBD)" with traditional ERCP. 111 patients with PAD complicated with choledocholithiasis were randomly divided into experimental group (n = 55, EST < 5 mm + EPBD) and control group (n = 56, conventional EST/EPBD). The primary endpoints were one-time stone clearance and adverse event rate, while secondary endpoints included operative time and common bile duct pressure. One-time stone clearance rate: test group 98.1% vs. control group 87.5% (P = 0.029) • Mean operation time: 24 ± 9 min vs. 31 ± 11 min (P < 0.001) • CBD pressure 6 days after surgery: 11.5 ± 2.3 vs. 8.5 ± 1.6 cm H₂O (P < 0.001) • Incidence of postoperative pancreatitis: 3.6% vs. 10.7% (P = 0.206). EST + EPBD can significantly improve stone removal efficiency, shorten operation time, and may improve long-term prognosis by preserving Oddi sphincter function.