Outcomes of Endoscopic Sphincteroplasty Using Large Balloon Dilatation for Difficult Common Bile Duct Stone Removal: A Single Endoscopist Experience
Chainarong Phalanusitthepha MD*, Chotirot Augkurawaranon MD*, Tassanee Sriprayoon MD*, Chananya Hokierti MD*, Thawatchai Akaraviputh MD*
Affiliation : * Siriraj GI Endoscopy Center, Minimally Invasive Surgery Unit, Division of General Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
Objective : Endoscopic sphincteroplasty (ESPT) using a large CRE™ Wireguided balloon dilatation is an alternative
technique in removing a difficult common bile duct (CBD) stone. However, the outcome and complications of endoscopic
difficult CBD stone removal using ESPT have not been well demonstrated. The present study revealed the outcome of the
technique which done by a single endoscopist.
Material and Method: Between January 2003 and December 2009, the retrospective study of ninety-three patients with
CBD stones that underwent endoscopic retrograde cholangiopancreaticography (ERCP) for stone removal and had difficulty
were enrolled. ESPT using a large CRE™ Wireguided balloon dilatation was performed in 62 patients. The success rate of
complete stone clearance and post ERCP complications were analyzed.
Results : In the aspect of complete stone removal, the success rate was 88.7%. Seven patients (11.3%) required adjunctive
mechanical lithotripsy (ML) for complete stone clearance. This technique was associated with low complication rate (3.2%).
Post ERCP bleeding was found in one patient (1.6%) with ESPT using a large CRE™ balloon dilatation. Mild post-ERCP
pancreatitis occurred in only one patient.
Conclusion : ESPT using large diameter CRE™ Wireguided balloon dilatation after biliary sphinctertomy is an effective
technique for a difficult CBD stone removal associated with a lower rate of complications. This procedure can avoid
unnecessary surgical CBD exploration for stone removal.
Keywords : Endoscopic sphincteroplasty, Balloon dilatation, Mechanical lithotripsy, Common bile duct stone
