Background and study aims: Endoscopic sphincterotomy followed by extraction using a Dormia basket or an extraction balloon catheter is the procedure that is generally used for the removal of bile duct stones. This is not successful in all patients, however, and some stones have to be extracted using lithotripsy devices. In an attempt to avoid mechanical lithotripsy, we used large-diameter balloons after sphincterotomy for removing stones that could not be extracted using the conventional methods.
Patients and methods: In this retrospective pilot study, large-diameter (15-mm, 18-mm, or 20-mm maximum sizes) balloon dilation of the sphincterotomy site was performed in 50 patients in whom bile duct stones could not be removed by endoscopic sphincterotomy and Dormia basket or balloon catheter extraction.
Results: The stones varied in size from < 15 mm to 25 mm. Common bile duct stones could be removed in all the patients using the large-diameter balloon technique. A Dormia basket or an extraction balloon catheter was required for removal of stones in 29 patients (58 %); and mechanical lithotripsy was required in five patients (10 %). Minor oozing of blood was seen in 16 patients (32 %), but the ooze stopped spontaneously during the endoscopy. Melena occurred in two patients and major bleeding requiring surgery occurred in one patient. Mild acute pancreatitis that resolved with conservative management occurred in four patients (8 %). There were no perforations and no deaths.
Conclusions: Large-diameter balloon dilation of the sphincterotomy site is an effective procedure for removal of bile duct stones that cannot be extracted by endoscopic sphincterotomy and conventional extraction devices. Mechanical lithotripsy could be avoided in the majority of these patients using this approach.
References
1
Binmoeller K F, Schafer T W.
Endoscopic management of bile duct stones.
J Clin Gastroenterology.
2001;
32
106-118
6
Ersoz G, Tekesin G, Ozutemiz A. et al .
Biliary sphincterotomy plus dilation with a large balloon for bile duct stones that are difficult to extract.
Gastrointest Endosc.
2003;
57
156-159
8
Hintze R E, Adler A, Veltzke W.
Outcome of mechanical lithotripsy of bile duct stones in an unselected series of 704 patients.
Hepatogastroenterology.
1996;
43
473-476
9
Cohello R, Bordas J M, Guevara M C. et al .
Mechanical lithotripsy during retrograde cholangiography in choledocholithiasis untreatable by conventional endoscopic sphincterotomy.
Gastroenterol Hepatol.
1997;
20
124-127
10
Cipoletta L, Costamagna G, Bianco M A. et al .
Endoscopic mechanical lithotripsy in difficult common bile duct stones.
Br J Surg.
1997;
84
1407-1409
11
Garg P, Tandon R K, Ahuja V. et al .
Predictors of unsuccessful mechanical lithotripsy and endoscopic clearance of bile duct stones.
Gastrointest Endosc.
2004;
59
688-690
15
Staritz M, Ewe K, Meyer zum Buschenfelde K H.
Endoscopic papillary dilation, a possible alternative to endoscopic papillotomy.
Lancet.
1982;
1
1306-1307
16
Bergman J J, Rauws F A, Fockens P. et al .
Randomized trial of endoscopic balloon dilation versus endoscopic sphincterotomy for removal of bile duct stones.
Lancet.
1997;
349
1124-1129
17
Komatsu Y, Kawabe T, Toda N. et al .
Endoscopic papillary balloon dilation for the management of common bile duct stones: experience of 226 cases.
Endoscopy.
1998;
30
12-17
18
Mathuna P M, White P, Clarke E. et al .
Endoscopic balloon sphincteroplasty (papillary dilatation) for bile duct stones: efficacy, safety and follow-up in 100 patients.
Gastrointest Endosc.
1995;
42
468-474
19
Staritz M, Poralla T, Dormeyer H H. et al .
Endoscopic removal of common bile duct stones through intact papilla after medical sphincter dilation.
Gastroenterology.
1985;
88
1807-1811
20
Ibuki Y, Kudo M, Todo A.
Endoscopic retrograde extraction of common bile duct stones with drip infusion of isosorbide dinitrate.
Gastrointest Endosc.
1992;
38
178-180
24
Valavianos P, Chopra K, Mandalia S. et al .
Endoscopic balloon dilation versus endoscopic sphincterotomy for the removal of bile duct stones: a prospective randomized trial.
Gut.
2003;
52
1165-1169
25
Disario J A, Freeman M L, Bjorkman D J. et al .
Endoscopic balloon dilation compared with sphincterotomy for extraction of bile duct stones.
Gastroenterology.
2004;
127
1291-1299
26
Baron T H, Harewood G C.
Endoscopic balloon dilation of the biliary sphincter compared to endoscopic biliary sphincterotomy for removal of common bile duct stones during ERCP: a meta-analysis of randomized controlled trials.
Am J Gastroenterol.
2004;
99
1455-1460
27
Minami A, Hirose S, Nomoto T. et al .
Small sphincterotomy combined with papillary dilation with large balloon permits retrieval of large stones without mechanical lithotripsy.
World J Gastroenterol.
2007;
13
2179-2182
28
Cotton P B, Lehman G, Vennes J. et al .
Endoscopic sphincterotomy, complications and their management: an attempt at consensus.
Gastrointest Endosc.
1991;
37
383-393
