Biliary sphincterotomy dilation for the extraction of difficult common bile duct stones.

Abstract

BACKGROUND AND AIM:

Endoscopic retrograde cholangiopancreatography (ERCP) with biliary sphincterotomy (BS) is the usual method for extracting common bile duct stones. However, following BS and by means of extraction balloons and Dormia baskets a complete bile duct clearance cannot be achieved in all cases. We present a study on the impact that hydrostatic balloon dilation of a previous BS (BSD) may have in the extraction rate of choledocholithiasis.

PATIENTS AND METHODS:

A prospective study which included 91 consecutive patients diagnosed with choledocholithiasis who underwent ERCP. For stone removal, extraction balloons and Dormia baskets were used, and when necessary BSD was employed.

RESULTS:

Complete bile duct clearance was achieved in 86/91 (94.5%) patients. BSD was used in 30 (33%) cases. In these cases, extraction was complete in 29/30 (97%); 23 (76%) patients in the BSD group had anatomic difficulties or bleeding disorders. The most frequently used hydrostatic balloon diameter was 15 mm (60%). There were 7 (7.6%) complications: two self-limited hemorrhage episodes in the BSD group and one episode of cholangitis, one of pancreatitis, and three of bleeding in the group in which BSD was not used.

CONCLUSIONS:

BSD is a very valuable tool for extracting common bile duct stones. In our experience, there has been an increase in the extraction rate from 73% (Rev Esp Enferm Dig 2002; 94: 340-50) to 94.5% (p = 0.0001, OR 0.1, CI 0.05-0.45), with no increase in complications.

• Authors: J García-Cano, L Taberna Arana, C Jimeno Ayllón, M Viñuelas Chicano, R Martínez Fernández, L Serrano Sánchez, C J Gómez Ruiz, M J Gómez xAriño, J I Pérez García, M G Pérez Vigara, E Redondo Cerezo, A Pérez Sola
• Journal: Revista espanola de enfermedades digestivas (Rev Esp Enferm Dig) Vol. 101 Issue 8 Pg. 541-5 (Aug 2009) ISSN: 1130-0108 [Print] Spain
• PMID: 19785493 (Publication Type: Comparative Study, Evaluation Study, Journal Article)

Topics

• Adult
• Aged
• Aged, 80 and over
• Ampulla of Vater
• Catheterization
• Cholangiopancreatography, Endoscopic Retrograde
• Choledocholithiasis (therapy)
• Female
• Follow-Up Studies
• Humans
• Male
• Middle Aged
• Prospective Studies
• Sphincterotomy, Endoscopic
• Time Factors