Feasibility of endoscopic papillary large balloon dilation to remove difficult stones in patients with nondilated distal bile ducts  

作　　者：Julio Carlos Pereira Lima Giusepe Saifert Moresco Ivan David Arciniegas Sanmartin Isabela Contin Guilherme Pereira-Lima Guilherme Watte Stephan Altmayer Carlos Eduardo Oliveira dos Santos 

机构地区：[1]Department of Gastroenterology,Endoscopy Division,Federal University of Health Sciences of Porto Alegre/Santa Casa Hospital,Porto Alegre 90020-090,RS,Brazil [2]Department of Biostatistics and Epidemiology,Pontifical Catholic University of Rio Grande do Sul,Porto Alegre 90619-900,RS,Brazil [3]Department of Gastroenterology and Endoscopy,Santa Casa Hospital,Bage96400-130,RS,Brazil

出　　处：《World Journal of Gastrointestinal Endoscopy》2022年第7期424-433,共10页世界胃肠内镜杂志（英文版）（电子版）

摘　　要：BACKGROUND Current guidelines recommend not performing papillary large balloon dilation in patients with nondilated distal bile ducts.AIM To assess the feasibility of balloon dilation to remove difficult stones in patients with nondilated distal bile ducts.METHODS Data from 1289 endoscopic retrograde cholangiopancreatography(ERCP)procedures were obtained from two prospective studies.While 258 cases had difficult stones(>1 cm,multiple>8,impacted,or having a thin distal duct),191 underwent biliary dilation up to 15 mm after endoscopic sphincterotomy.Cholangiographies of these cases were retrospectively reviewed in order to classify the distal bile duct and both the stone size and number.Primary outcomes were clearance rate at first ERCP and complications.RESULTS Of the 191 patients(122 women and 69 men;mean age:60 years)who underwent biliary dilation for difficult stones,113(59%)had a nondilated or tapered distal duct.Patients with a dilated distal duct were older than those with nondilated distal ducts(mean 68 and 52 years of age,respectively;P<0.05),had more stones(median 4 and 2 stones per patient,respectively;P<0.05),and had less need for additional mechanical lithotripsy(6.4%vs 25%,respectively;P<0.05).Clearance rate at first ERCP was comparable between patients with a dilated(73/78;94%)and nondilated distal ducts(103/113;91%).Procedures were faster in patients with a dilated distal duct(mean 17 vs 24 min,respectively;P<0.005).Complications were similar in both groups(6.4%vs 7.1%,respectively).CONCLUSION Large balloon dilation for difficult stones is feasible in patients with a nondilated or even tapered distal duct.

关 键 词：Difficult bile duct stones Endoscopic retrograde cholangiopancreatography Balloon dilation Complications Biliary dilation CHOLANGIOGRAPHY 

分 类 号：R657.4[医药卫生—外科学]