Еndoscopic papillosphincterotomy with balloon dilation in treatment of patients with coldocholithiasis and parapapillary diverticule (balloon dilation for coldocholithiasis)

Performing a limited papillosphincterotomy, supplemented by endoscopic balloon dilation, and only endoscopic papillosphincterotomy in patients with choledocholithiasis and parapapillary diverticulum resulted in complete lithoextraction in 92.9% of cases, and adequate drainage of the common bile duct in 100% and 96.4% of cases, respectively. The use of balloon dilation after limited papillosphincterotomy definitely reduces the need for mechanical lithotripsy and the number of postoperative complications.

Partial papillosphincterotomy with balloon dilatation in the treatment of choledocholytiasis in patients with parapapillary diverticulum

Results of treatment of 42 patients suffering from choledocholytiasis and parapapillary diverticle are compared, by which for treatment limited papillosfincterotomy supplemented with endoscopic balloon dilatation is performed with results of treatment of 56 patients with similar pathology, by which traditional endoscopic papillosfincterotomy was performed. Limited papillosphincterotomy with endoscopic balloon dilatation resulted in complete lithoextraction in 92.9% of cases as compared to 92.8% with endoscopic papillosphincterotomy only; an adequate drainage of extrahepatic bile ducts was achieved in 100% and 96.4%, respectively (p 0.05). With endoscopic papillosphincterotomy, full removal of all concretions with a diameter of less than one centimeter was achieved without mechanical lithotripsy; for concretions from 1 to 1.5 cm in size the mechanical lithotripsy was necessary in 45.5% of cases. Limited papillosphincterotomy with endoscopic balloon dilatation allowed lithoextraction of concretions with a diameter of up to 1.5 cm without mechanical lithotripsy in all patients. The mechanical lithotripsy for concretions with a diameter above 1.5 cm was necessary in 60% of cases for both methods. In the treatment arm, two (4.8%) cases with complications were observed, while in the control arm there were 13 (23.2%) cases (p = 0.012). Acute pancreatitis was the only postoperative complication for which significant difference was observed (р = 0.043). In addition, after endoscopic papillosphincterotomy the incidence of bleeding from the suture line was 3.6% and the incidence of perforation of diverticula was 3.6%; this required an open surgery. The above mentioned demonstrates the advantages of limited papillosphincterotomy with endoscopic balloon dilatation over endoscopic papillosphincterotomy to resolve choledocholytiasis in the presence of parapapillary diverticulum.

The effect of duration time on the efficacy and safety during endoscopic papillary balloon dilation for choledocholithiasis treatment

Background Endoscopic papillary balloon dilation (EPBD) has been widely accepted as an alternative to endoscopic sphincterotomy (EST) during therapeutic endoscopic retrograde cholangiopancreatography (ERCP) for choledocholithiasis treatment. No consensus has been established to define the precise duration of EPBD. Methods The PubMed, EMBASE, Cochrane Library database were systematically searched up to 31 May 2019 for research comparing short duration (≤ 30 seconds) and long duration (≥ 1 minute) of EPBD. Results Seven studies demonstrated that EPBD with long duration was superior than short duration in the stone clearance rate during the first ERCP (OR 0.61, 95%CI [0.48, 0.77], P < 0.001). Long duration exhibited a trend of higher efficacy in total stone removal across all ERCP sessions (OR 0.98, 95%CI [0.73, 1.31], P = 0.89), less frequency of mechanical lithotripsy use (OR 1.22, 95%CI [0.79, 1.89], P = 0.37). Compared with long duration, short balloon time had lower rate of overall complications (OR 0.85, 95%CI [0.70, 1.04], P = 0.11) and post-ERCP pancreatitis (OR 0.81, 95%CI [0.63, 1.03], P = 0.09). No significance was identified in hemorrhage (OR 0.86, 95%CI [0.30, 2.44], P = 0.77), perforation (OR 0.54, 95%CI [0.14, 2.14], P = 0.38) and cholangitis (OR 1.15, 95%CI [0.80, 1.66], P = 0.44). Conclusion Long duration (≥ 1 minute) could significantly increase the efficacy of EPBD in stone removal rate during first ERCP session, manifesting higher rate of total CBD stone clearance and less mechanical lithotripsy. Short EPBD contributed to less overall complications than long EPBD but not significantly.