scholarly journals Complex biliary stones management: cholangioscopy versus papillary large balloon dilation – a randomized controlled trial

2018 ◽  
Vol 06 (02) ◽  
pp. E131-E138 ◽  
Author(s):  
Tomazo Franzini ◽  
Renata Moura ◽  
Priscilla Bonifácio ◽  
Gustavo Luz ◽  
Thiago de Souza ◽  
...  
Keyword(s):  
Adverse Events ◽  
Success Rate ◽  
Balloon Dilation ◽  
Success Rates ◽  
Biliary Stones ◽  
Stone Removal ◽  
Large Balloon ◽  
Group 2 ◽  
Large Balloon Dilation ◽  
Group 1

Abstract Background and study aims Endoscopic removal of biliary stones has high success rates, ranging between 85 % to 95 %. Nevertheless, some stones may be challenging and different endoscopic methods have evolved. Papillary large balloon dilation after sphincterotomy is a widely used technique with success rates ranging from 68 to 90 % for stones larger than 15 mm. Cholangioscopy allows performing lithotripsy under direct biliary visualization, either by laser or electrohydraulic waves, which have similar success rate (80 % – 90 %). However, there is no study comparing these 2 techniques. Patients and methods From April 2014 to June 2016, 100 patients were enrolled and randomized in 2 groups, using a non-inferiority hypothesis: cholangioscopy + electrohydraulic lithotripsy (group 1) and endoscopic papillary large balloon dilation (group 2). The main outcome was complete stone removal. Adverse events were documented. Mechanical lithotripsy was not performed. Failure cases had a second session with crossover of the methods. Results The mean age was 56 years. 74 (75.5 %) patients were female. The initial overall complete stone removal rate was 74.5 % (77.1 % in group 1 and 72 % in group 2, P > 0.05). After second session the overall success rate achieved 90.1 %. Procedure time was significantly lower in group 2, – 25.2 min (CI95 % – 12.48 to – 37.91). There were no significant differences regarding technical success rate, radiologic exposure and adverse events. Conclusion Single-operator cholangioscopy-guided lithotripsy and papillary large balloon dilation are effective and safe approaches for removing complex biliary stones.

Multicenter randomized trial of endoscopic papillary large balloon dilation without sphincterotomy versus endoscopic sphincterotomy for removal of bile duct stones: MARVELOUS trial

Endoscopy ◽  
2020 ◽  
Vol 52 (09) ◽  
pp. 736-744 ◽  
Author(s):  
Hirofumi Kogure ◽  
Shuhei Kawahata ◽  
Tsuyoshi Mukai ◽  
Shinpei Doi ◽  
Takuji Iwashita ◽  
...  
Keyword(s):  
Bile Duct ◽  
Adverse Events ◽  
Randomized Trial ◽  
Endoscopic Sphincterotomy ◽  
Balloon Dilation ◽  
Single Session ◽  
Stone Removal ◽  
Cbd Stones ◽  
Large Balloon ◽  
Large Balloon Dilation

Abstract Background Endoscopic papillary large balloon dilation (EPLBD) has been increasingly used for the management of large common bile duct (CBD) stones. Although EPLBD is often preceded by endoscopic sphincterotomy (EST), EPLBD alone without EST has been increasingly reported as an alternative to EST for large CBD stones. Methods This multicenter randomized trial was conducted at 19 Japanese institutions to compare the efficacy and safety of EPLBD alone versus EST for the removal of large (≥ 10 mm) CBD stones. The primary end point was complete stone removal in a single session. The secondary end points included: overall complete stone removal, lithotripsy use, procedure time, adverse events, and cost. Results 171 patients with large CBD stones were included in the analysis. The rate of single-session complete stone removal was significantly higher in the EPLBD-alone group than in the EST group (90.7 % vs. 78.8 %; P = 0.04). Lithotripsy use was significantly less frequent in the EPLBD group than in the EST group (30.2 % vs. 48.2 %; P = 0.02). The rates of early adverse events were comparable between the two groups: rates of overall adverse events were 9.3 % vs. 9.4 % and of pancreatitis were 4.7 % vs. 5.9 % in the EPLBD and EST groups, respectively. The procedure costs were $1442 vs. $1661 in the EPLBD and EST groups, respectively (P = 0.12). Conclusion EPLBD without EST for the endoscopic treatment of large CBD stones achieved a significantly higher rate of complete stone removal in a single session compared with EST, without increasing adverse events.

scholarly journals Difficult Biliary Stones: A Comprehensive Review of New and Old Lithotripsy Techniques

Medicina ◽  
2022 ◽  
Vol 58 (1) ◽  
pp. 120
Author(s):  
Edoardo Troncone ◽  
Michelangela Mossa ◽  
Pasquale De Vico ◽  
Giovanni Monteleone ◽  
Giovanna Del Vecchio Blanco
Keyword(s):  
Balloon Dilation ◽  
Common Bile Duct Stones ◽  
Endoscopic Management ◽  
Stone Extraction ◽  
Biliary Stones ◽  
Electrohydraulic Lithotripsy ◽  
Biliary Sphincterotomy ◽  
Single Operator ◽  
Large Balloon ◽  
Large Balloon Dilation

Biliary stones represent the most common indication for therapeutic endoscopic retrograde cholangiopancreatography. Many cases are successfully managed with biliary sphincterotomy and stone extraction with balloon or basket catheters. However, more complex conditions secondary to the specific features of stones, the biliary tract, or patient’s needs could make the stone extraction with the standard techniques difficult. Traditionally, mechanical lithotripsy with baskets has been reported as a safe and effective technique to achieve stone clearance. More recently, the increasing use of endoscopic papillary large balloon dilation and the diffusion of single-operator cholangioscopy with laser or electrohydraulic lithotripsy have brought new, safe, and effective therapeutic possibilities to the management of such challenging cases. We here summarize the available evidence about the endoscopic management of difficult common bile duct stones and discuss current indications of different lithotripsy techniques.

Comparison of the Toxicity of Amphotericin B in 5% Dextrose with That of Amphotericin B in Fat Emulsion in a Randomized Trial with Cancer Patients

1999 ◽  
Vol 43 (6) ◽  
pp. 1445-1448 ◽  
Author(s):  
Marcio Nucci ◽  
Monique Loureiro ◽  
Fernanda Silveira ◽  
Anna Raquel Casali ◽  
Luis Fernando Bouzas ◽  
...  
Keyword(s):  
Adverse Events ◽  
Randomized Trial ◽  
Cancer Patients ◽  
Amphotericin B ◽  
Fungal Infections ◽  
Serum Levels ◽  
Success Rates ◽  
Fat Emulsion ◽  
Group 2 ◽  
Group 1

ABSTRACT A multicentric randomized trial was undertaken to compare the toxicity of amphotericin B in 5% dextrose with that of amphotericin B in a fat emulsion (Intralipid) in cancer patients. Group 1 (n = 33) received amphotericin B diluted in 5% dextrose with premedication consisting of promethazine plus an antipyretic. Group 2 (n = 28) received amphotericin B diluted in 20% Intralipid without premedication. Amphotericin B was infused daily at a dose of 1 mg/kg of body weight over a 1-h period to members of both groups for empirical antifungal therapy (in neutropenic patients) or for the treatment of documented fungal infections. The majority of patients (80%) received empirical amphotericin B treatment. The two groups were comparable with regard to age, gender, underlying disease, and the following baseline characteristics: use of other nephrotoxic drugs and serum levels of potassium and creatinine. The median cumulative doses of amphotericin B were 240 mg in group 1 and 245 mg in group 2 (P = 0.73). Acute adverse events occurred in 88% of patients in group 1 and in 71% of those in group 2 (P = 0.11). Forty percent of the infusions in group 1 were associated with fever, compared to 23% in group 2 (P < 0.0001). In addition, patients in group 2 required less meperidine for the control of acute adverse events (P = 0.008), and fewer members of this group presented with hypokalemia (P = 0.004) or rigors (P < 0.0001). There was no difference in the proportions of patients with nephrotoxicity (P = 0.44). The success rates of empirical antifungal treatment were similar in the two groups (P = 0.9). Amphotericin B diluted in a lipid emulsion seems to be associated with a smaller number of acute adverse events and fewer cases of hypokalemia than amphotericin B diluted in 5% dextrose.

Endoscopic papillary large balloon dilation in patients with large biliary stones and periampullary diverticula: Results of a multicentric series

2018 ◽  
Vol 50 (8) ◽  
pp. 828-832 ◽  
Author(s):  
Claudio Zulli ◽  
Giuseppe Grande ◽  
Gian Eugenio Tontini ◽  
Orazio Labianca ◽  
Girolamo Geraci ◽  
...  
Keyword(s):  
Balloon Dilation ◽  
Biliary Stones ◽  
Large Balloon ◽  
Large Balloon Dilation

Risk Factors for Perforation During Endoscopic Papillary Large Balloon Dilation and Bile Duct Stone Removal

2021 ◽  
Author(s):  
Hiroshi Yamauchi ◽  
Tomohisa Iwai ◽  
Kosuke Okuwaki ◽  
Eiji Miyata ◽  
Yusuke Kawaguchi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Bile Duct ◽  
Bile Duct Stone ◽  
Balloon Dilation ◽  
Stone Removal ◽  
Large Balloon ◽  
Large Balloon Dilation

scholarly journals Effect of Age on Primary Balloon Dacryocystoplasty and Probing Success in Congenital Nasolacrimal Duct Obstruction

2021 ◽  
Author(s):  
Volkan Dericioğlu ◽  
Mehmet Orkun Sevik ◽  
Sena Sümmen Saçu ◽  
Muhsin Eraslan ◽  
Eren Cerman
Keyword(s):  
Success Rate ◽  
Age Groups ◽  
Nasolacrimal Duct ◽  
Success Rates ◽  
Congenital Nasolacrimal Duct Obstruction ◽  
Duct Obstruction ◽  
Group 3 ◽  
Group 2 ◽  
Effect Of Age ◽  
Group 1

Abstract Purpose: To compare the success rates of balloon dacryocystoplasty (BDP) and probing as a primary procedure in congenital nasolacrimal duct obstruction (CNLDO) and investigate the effect of age on both procedures.Methods: A total of 135 patients (171 eyes) with simple or incomplete complex CNLDO were included in this retrospective study; complete complex CNLDO cases were excluded. The success rates for primary BDP (118 eyes) and for probing (53 eyes) were compared as overall and among the age groups; Group 1 (12–24 months old), Group 2 (25–36 months old), and Group 3 (> 36 months old).Results: Mean age of the patients was 41.5±27.2 months for primary BDP, and 21.8±10.8 months for probing (p<0.001). Overall success rates for primary BDP and probing were 81.1% (43/53) and 76.3% (90/118), respectively (p=0.481). Success rates for BDP and probing among age groups were, 93.8% and 85.3% in Group 1 (p=0.306), 93.3% and 50.0% in Group 2 (p=0.012), and 63.6% and 27.3% in Group 3 (p=0.052), respectively. Cox regression analysis showed that the median ages were 18 months for probing and 36 months for primary BDP. Poisson regression model showed that, for every one-month increase in patients’ age, the success rate of probing decreased by 9.7%.Conclusion: Probing success decreased to a point where different treatment options such as primary BDP can be discussed with the patient’s parents after 18 months of age. The success of BDP decreased after 36 months, while it maintained a high success rate between 24-36 months as primary treatment.

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