Endoscopy 2021; 53(S 01): S78
DOI: 10.1055/s-0041-1724446
Abstracts | ESGE Days
ESGE Days 2021 Oral presentations
Saturday, 27 March 2021 12:00 – 12:45 Difficult bile stones in year 2021 Room 5

Efficacy Of Ercp For Difficult Bile Duct Stone Clearance: Endoscopic Papillary Balloon Dilation With Stent Versus Stent

M Alburquerque
1   Clínica Girona, Gastroenterology, Girona, Spain
2   Hospital de Palamós, Gastroenterology, Girona, Spain
,
N Zaragoza
3   Hospital Universitario Arnau de Vilanova, Gastroenterology, Lleida, Spain
,
I Miguel
3   Hospital Universitario Arnau de Vilanova, Gastroenterology, Lleida, Spain
,
M Figa
1   Clínica Girona, Gastroenterology, Girona, Spain
,
E Pijoan
3   Hospital Universitario Arnau de Vilanova, Gastroenterology, Lleida, Spain
,
JM Miñana
3   Hospital Universitario Arnau de Vilanova, Gastroenterology, Lleida, Spain
,
A Vargas
1   Clínica Girona, Gastroenterology, Girona, Spain
2   Hospital de Palamós, Gastroenterology, Girona, Spain
,
G Torres
3   Hospital Universitario Arnau de Vilanova, Gastroenterology, Lleida, Spain
,
JM Reñe
3   Hospital Universitario Arnau de Vilanova, Gastroenterology, Lleida, Spain
,
F González-Huix
1   Clínica Girona, Gastroenterology, Girona, Spain
3   Hospital Universitario Arnau de Vilanova, Gastroenterology, Lleida, Spain
,
SEED Working Group on ERCP › Author Affiliations
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    Aims To compare the efficacy of endoscopic papillary balloon dilation with stent (EPBD-s) vs. only stent (OS) for difficult bile duct stone clearance.

    Methods Comparative analysis of a multicenter prospective endoscopy database (2009-2019) including consecutive patients with naive papilla undergone first ERCP for bile duct stones. Efficacy of EPBD-s vs. OS in following ERCPs was compared.

    Results There were included 1615 patients (age: 73.3 ±0.39 years old, 52.9 % women). Unsuccessful clearance: 6.6 % (107 patients). In a multivariate analysis, diameter of largest stone >15mm, OR: 8.08 (95 %CI: 4.74 -13.77), number >10 stones, OR: 2.66 (95 %CI: 1.16 -6.09), stricture below stone, OR: 17.10 (95 %CI: 7.47 -39.11), post-surgical anatomical biliary disturbances (Billroth-II, Roux-en-Y), OR: 4.54 (95 %CI: 1.28 -16.12), and common bile duct (CBD) diameter >13mm, OR: 1.81 (95 %CI: 1.09 -3.01) were associated with unsuccessful clearance.

    Of 107 patients with unsuccessful clearance, 97 undergone subsequent ERCPs. In 49/97 (50.52 %), EPBD-s was performed and in 48/97 (49.48 %), OS. After subsequent ERCPs, a complete clearance was not achieved in 28/97 patients (28,8 %). EPBD-s achieved a higher clearance rate (40/49, 81.6 %) than Os (29/48, 60,4 %), p=0,026; and it was the only predictor of final complete clearance, OR: 2.91 (95 %CI: 1.15 -7.35). There was no difference in complication rate, EPBD-s =14.3 % vs. Os =14.6 %, p =0.97.

    Conclusions Endoscopic papillary balloon dilation with stent is superior over only stent for difficult bile duct stone clearance. This strategy (EPBD-s) should be ever raised in patients with biliary stones >15mm, number >10 stones, located above strictures, with post-surgical anatomical biliary disturbances and CBD diameter >13mm.

    Citation: Alburquerque M, Zaragoza N, Miguel I et al. OP189 EFFICACY OF ERCP FOR DIFFICULT BILE DUCT STONE CLEARANCE: ENDOSCOPIC PAPILLARY BALLOON DILATION WITH STENT VERSUS STENT. Endoscopy 2021; 53: S78.


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    Publication History

    Article published online:
    19 March 2021

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