sphincteroplasty cbdDecember 15, 2021
Objective: Endoscopic sphincteroplasty (ESPT) using a large CRETM 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.
Introduction Extraction of large (>1 cm) CBD stones at ERCP is often difficult despite adequate sphincterotomy. Failure of extraction of stones warrants repeat ERCPs and also referral to advanced techniques such as extracorporeal shock wave lithotripsy which is not readily available in UK centres. We believe that balloon sphincteroplasty is a safe and effective procedure which is underutilised. We describe a large district general hospital experience of use of balloon sphincteroplasty in a cohort of elderly patients.
Methods All patients who underwent balloon sphincteroplasty since June 2012 at Princess Royal Hospital, Bromley were identified from endoscopy database. Patients demographics, sedation dose, size of balloon sphincteroplasty, success rate of CBD stones clearance and complications were examined.
Conclusion In our district general hospital cohort of elderly patients, Balloon sphincteroplasty was found to be safe and effective procedure in extraction of large common bile duct stones. Complete extraction of CBD stones was achieved in 97% of patients. One patient had mild pancreatitis, one had mild bleeding and there was no of perforations observed. Balloon sphincteroplasty was particularly useful in patients with peri-ampullary divericulm in whom a generous sphincterotomy could be risky. Balloon sphincteroplasty had prevented the further need for ERCP, and its associated cost and morbidity.
One patient developed uncomplicated pancreatitis who recovered with conservative management. One patient had minor bleeding which settled spontaneously. None of the patients had perforations. Stone clearance was incomplete in one patient due to to a small proximal stone floated up in to the left hepatic duct. On median follow up of 6 months 1 patient underwent repeat ERCP for recurrence of stones.
Results A Total of 29 patients underwent balloon sphicteroplsty. 8 (27%) of these patients had previous unsuccessful attempt at ERCP removal of stones. All patients had sphincterotomy prior to sphincteroplasty. Mean age of patients was 72 years. There were 20 female and 9 male patients. Mean dose of Midazolam was 4 mg and Fentanyl 75 mg. Mean size of the CBD stones in these patients was 13 mm (range 10–20 mm). 8 patients had large peri-ampullary diverticulum (6 patients had ampulla at the edge of diverticulam, one <5 mm).
Balloon sphincterotoplasty using Boston Scientific CRE balloon was performed. Mean size of balloon sphincteroplasty was 14 mm (range 10–20 mm and median 15 mm). Stone retrieval basket was used in 6 patients. Complete extraction of CBD stones was documented in 28 of 29 (97%) patients.
Reference Maydeo A, Bhandari S, et al., Endoscopy 2007; 39 (11)