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• W2078765737 abstract "Background: Endoscopic sphincterotomy (ES) has become an established therapeutic procedure, predominantly in the treatment of choledocholithiasis. In patients who have large stones, stone retrieval is technically difficult, particularly when a mechanical lithotriptor is required to crushing them. This problem may be solved by a new method we call “Endoscopic Papillary Large Balloon Dilation (EPLBD) combined with ES” which we herein present. Patients and Methods: Retrieval of large biliary stones was performed in six patients. Mean stone size was 17±3mm and mean number of stones was 2.7±1.4. Firstly, ES with a small incision up to the pancreatic orifice was performed over a wire guide. Next, endoscopic papillary dilation was performed for three minutes with a large balloon (20mm max in diameter) to slowly match the size of the bile duct. Stones were then retrieved from the biliary duct with a balloon and a basket. After stone retrieval, the bile duct was washed with normal saline to check for remaining stones. Before performing this new method, we compared 30 cases each of endoscopic papillary dilation with a small balloon combined with ES vs EPD (endoscopic papillary dilation). This comparison suggested that a small incision prevents pancreatic injury after EPD. We therefore performed EPLBD with small ES. Results: Stone retrieval was successful in all cases without the need to crush large stones. Mean procedure time was 34±5 minutes. Dilating the papillary orifice with a large balloon made it possible to remove large stones smoothly without crushing them. This also helped to make confirmation of remaining stones easy. After dilation with the large balloon, there were some instances of oozing, but no perforations. No post-procedural pancreatitis and no cholangitis occurred. Discussion: EPLBD combined with a small ES was effective for the retrieval of large biliary stones without the use of mechanical lithotripsy. Although ES with a large incision may be effective in reducing the indication of mechanical lithotripsy, a large incision has a higher risk of perforation and bleeding than a normal ES. Our new method, incorporating a slow dilation of the papilla up to a large diameter, could provide a larger opening than a large ES and could prevent perforation and bleeding. This method of stone retrieval is easy to perform and may be able to play a role in the treatment of large and multiple bile duct stones." @default.
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• W2078765737 date "2004-04-01" @default.
• W2078765737 modified "2023-09-26" @default.
• W2078765737 title "Small Sphincterotomy Combined with Papillary Dilation with Large Balloon Permits Retrieval of Large Stones Without Crushing Them" @default.
• W2078765737 doi "https://doi.org/10.1016/s0016-5107(04)00927-7" @default.
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