Journal List > Korean J Gastroenterol > v.57(6) > 1006823

Ha, Song, Kim, Kim, Heo, Lee, Cho, and Jeon: Recurrent Common Bile Duct Stone and Endoscopic Treatment after Endoscopic Papillary Large Balloon Dilatation with Minor Endoscopic Sphincterotomy

Abstract

Background/Aims

Recent studies have reported the potentials of endoscopic papillary large balloon dilatation (EPLBD) with minor endoscopic sphincterotomy (EST) for the complete removal of common bile duct (CBD) stone in the high risk groups. However, there have been no reports about the recurrence of the CBD stone after EPLBD with minor EST. The aim of this study was to evlauate the recurrence of CBD stone after EPLBD with minor EST.

Methods

A total of 1,036 patients who underwent endoscopic treatment due to CBD stones at Pusan University Hospital were enrolled. The patients were classified into two groups: those who underwent EPLBD with minor EST (group 1) and those who underwent EST treatment (group 2). We investigated clinical factors and recurrence rate between two groups.

Results

The recurrence of CBD stone occurred in total of 74 patients (7%), and the recurrence rates of CBD stone were 21/321 (6.5%) in Group 1 and 53/715 (7.4%) in Group 2. There were no difference in the presence of diverticulum and the number and size of recurrent CBD stone between the two groups. In case of diverticulum existence, recurrence rates were 12/158 (7.6%) in Group 1 and 21/101 (20.8%) in Group 2. When compared to the case of no diverticulum existence (Group 1: 9/163 [5.5%], Group 2: 32/614 [5.2%]), the recurrence rate of CBD stone was significantly lower if treated after EPLBD with minor EST (p<0.01).

Conclusions

CBD stone that recurs after going through EPLBD with minor EST can be successfully removed with an endoscopic treatment. The recurrence of CBD stone was especially lower in cases with periampullary diverticulum and treated with EPLBD with minor EST. Our results will be helpful in endoscopic retreatment and preventing the recurrence of CBD stone.

References

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Fig. 1.
Flow chart of study patients. EST, Endoscopic sphincterotomy; EPLBD, Endoscopic papillary large balloon dilatation; CBD, Common bile duct; GB, Gallbladder; IHD, Intrahepatic duct.
kjg-57-352f1.tif
Table 1.
Baseline Characteristics of Patients (n=1,036)
  EPLBD & minor EST (Group 1) n=321 EST (Group 2) n=715
Mean age (mean±SD, years) 65.6±15 63.5±15
Male/female 148/173 323/392
Number of CBD stone 2.4 1.8
Periampullary diverticulum (%) 102 (32%) 214 (30%)
Size of CBD stone (mm) 1.4 1.1
UDCA and/or Rowachol medication (%) 208 (65%) 496 (69%)
History of cholecystectomy (%) 61 (19%) 150 (20%)
Early complication (%) 14 (4%) 25 (3%)
Recurrence of CBD stone (%) 21 (6.5%) 53 (7.4%)

CBD, common bile duct; EST, endoscopic sphincterotomy; EPLBD, endoscopic papillary large balloon dilatation; UDCA, ursodeoxycholic acid.

Table 2.
Feature of Patients Who Had Recurrent CBD Stone (n=74)
  EPLBD & Minor EST (Group 1) n=21 EST (Group 2) n=53 p-value
Mean age (mean±SD, years) 68.9±15.1 67.9±15.6 0.92
Male/female 9/12 30/23 0.29
Number of recurrent CBD stone 2.3 (1–8) 1.6 (1–6) 0.03
Size of recurrent CBD stone (mm) 9.2 (5–18) 10.6 (5–40) 0.29
Recurrence interval (month) 11.8 (3–25) 17.5 (3–47) 0.04
Recurrence number 2.7 (2–5) 2.4 (2–5) 0.28
Periampullary diverticulum (%) 12 (57%) 21 (40%) 0.17
 1 type 4 (19%) 8 (15%) NS
 2 type 5 (40%) 13 (85%) 0.27
UDCA and/or Rowachol medication (%) 21 (100%) 53 (100%) NS
History of cholecystectomy (%) 5 (24%) 9 (17%) 0.52
Early complication (%) 3 (14%) 6 (11%) 0.21
Number of procedure (%) 1.3 (1–2) 1.4 (1–2) 0.31
Additional EPBD or EST 9 (43%) 17 (32%) NS
Mechanical lithotomy (%) 0 5 (10%)  
Endoscopic removal of CBD stone (%) 21 (100%) 53 (100%)  

CBD, common bile duct; EPBD, endoscopic papillary balloon dilatation; EST, endoscopic sphincterotomy; NS, non specific; UDCA, ursodeoxycholic acid.

Table 3.
Recurrence Rate according to Presence of Periamupullary Diverticulum (n=1,036)
Periampullary diverticulum EPLBD&Minor EST (Group 1)(n=21/321) EST (Group 2) (n=43/715) p-value
Presence 7.6% (12/158) 20.8% (21/101) <0.01
Absence 5.5% (9/163) 5.2% (32/614) 0.87

EPLBD, endoscopic papillary large balloon dilatation; EST, endoscopic sphincterotomy.

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