Large balloon dilatation versus endoscopic complete sphincterotomy in patients with large common bile duct stone(s) and periampullary diverticulum

Abstract

Abstract Background Endoscopic papillary large balloon dilatation (EPLBD) is an effective technique in treating large common bile duct (CBD) stones. However, the efficacy and safety of EPLBD in the setting of periampullary diverticula (PAD) are prospectively lacking. This study aimed to compare the effectiveness and short-term safety of EPLBD after limited sphincterotomy with those of endoscopic sphincterotomy (EST) for extracting large CBD stones in the setting of PAD prospectively. Methods Forty-eight patients with large CBD stone(s) > 1 cm were recruited. All patients had a PAD. Before the procedure, patients were evaluated by history taking, clinical examination, full investigations including proper imaging studies. During the procedure, patients were randomized to either group I: patients treated with EPLBD after limited sphincterotomy, and group II: patients treated with EST. CBD clearance was defined as a single procedure (EPLBD vs EST), single session (no repeat ERCP), and non-assisted (no lithotripsy used) stone extraction. After the procedure, patients were hospitalized with clinical, laboratory, and imaging assessment. Results The overall stone extraction rate in the current study was only 77.3% ( n = 34). The efficacy of stone extraction was significantly higher in the EPLBD ( n = 21,87.5%) group compared to the EST ( n = 13, 54.17%) group ( p = 0.011). The procedure-related adverse events were lower in the EPLBD group compared to the EST group. Pancreatitis was significantly higher in the EST ( n = 6, 25%) group than in the EPLBD ( n = 1, 4.1%) group ( p = 0.04). There was no significant difference between the two groups regarding postoperative bleeding and cholangitis. There were no perforations or case fatalities in either group. Conclusion Compared to EST, EPLBD is a more effective and safer method for extraction of large CBD stone(s) in the setting of PAD.