Prospective comparative study of endoscopic papillary large balloon dilation and endoscopic sphincterotomy for removal of large bile duct stones in patients above 45 years of age

Title
Prospective comparative study of endoscopic papillary large balloon dilation and endoscopic sphincterotomy for removal of large bile duct stones in patients above 45 years of age
Author(s)
김태년오명진
Keywords
POST-ERCP PANCREATITIS; BILIARY SPHINCTEROTOMY; PRESERVE SPHINCTER; RANDOMIZED-TRIAL; ODDI FUNCTION; COMPLICATIONS; DILATATION; MULTICENTER; PREVENTION; MANAGEMENT
Issue Date
201209
Publisher
INFORMA HEALTHCARE
Citation
SCANDINAVIAN JOURNAL OF GASTROENTEROLOGY, v.47, no.8-9, pp.1071 - 1077
Abstract
Objective. Although endoscopic papillary large balloon dilation (EPLBD) with limited endoscopic sphincterotomy (ES) showed excellent outcomes for treatment of large bile duct stones, hemorrhage and recurrence of stones are problematic complications. Recent studies suggest that EPLBD alone is safe and effective for removal of large bile duct stones. This study aimed to determine the therapeutic outcomes and safety of EPLBD, compared with ES, for removal of large bile duct stones. Material and methods. Eighty-three patients above 45 years of age with bile duct stones >1 cm in diameter were randomized to EPLBD and ES groups for removal of common bile duct stones from September 2010 to August 2011. Prophylactic gabexate mesilate was given to all patients. Results. Baseline characteristics were not significantly different, except diabetes and gallbladder stones between the EPLBD group (n = 40) and ES group (n = 43). The overall complete stone removal rate in each group was 97.5% (39/40) and 95.3% (41/43), respectively (p = 0.600). Requirement of mechanical lithotripsy was not significantly different between the EPLBD and ES group (10% vs. 21%, p = 0.171). Complete ductal clearance in one session was achieved in 82.4% and 81.4% of cases in each group, respectively (p = 0.577). There were no differences in complication rates between the EPLBD and ES group; pancreatitis, 5.0% vs. 7.0%; hemorrhage, 10.0% vs. 16.3%; acute cholangitis, 5.0% vs. 2.3%, and perforation, 2.5% vs. 0%. Conclusions. The therapeutic outcomes and complications of EPLBD for removal of large bile duct stones are comparable to those of ES.
URI
http://hdl.handle.net/YU.REPOSITORY/27338http://dx.doi.org/10.3109/00365521.2012.690046
ISSN
0036-5521
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의과대학 > 내과학교실 > Articles
의과대학 > 영상의학과학교실 > Articles
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