Small sphincterotomy combined with papillary dilation with large balloon permits retrieval of large stones without mechanical lithotripsy

AIM： TO introduce a new method： small endoscopic sphincterotomy （ES） combined with endoscopic papillary large balloon dilation （SES ＋ EPLBD） to treat patients with large biliary stones.METHODS： Retrieval of large biliary stones was performed in 88 patients. Mean stone size was 14 ± 3 mm and mean number of stones was 2.5 ± 3.5. Firstly, ES with a small incision was performed. Next, endoscopic papillary dilation was performed with a large balloon to slowly match the size of the bile duct. Stones were then retrieved from the biliary duct with a balloon and a basket.RESULTS： Stone retrieval was successful in all cases except one cystic duct stone case without the need to crush large stones. Mean procedure time was 30 ± 5 min. Dilating the papillary orifice with a large balloon made it possible to remove large stones smoothly without crushing them. After dilation with the large balloon, there were some instances of oozing, but no perforations. One instance of post-procedural pancreatitis （1%） occurred. CONCLUSION： SES ＋ EPLBD was effective for the retrieval of large biliary stones without the use of mechanical lithotripsy.

CLINICAL OBSERVATION ON TREATMENT OF ANAL FISSURE BY APPLYING SPHINCTEROTOMY WITH ACUPOTOM

Objective: To observe the therapeutic effect and features of acupotomy in the treatment of anal fissure. Methods: Seventy-six cases with anal fissure were randomly divided into two groups, namely, acupotomy group in which 37 patients were treated by anal internal sphincterotomy with acupotomy, and conventional anal sphincterotomy group (conventional group, n=39) that was treated by conventional amputation of the anal sphincter. Results: After treatment, twenty-six over 37 cases in acupotomy group recovered completely and the other 9 cases were improved clinically, with the total effective rate being 94.59%. In conventional group, 27 over 39 cases recovered completely and the other 11 cases were improved clinically. The total effective rate was 97.44%. There was no significant difference in the curative rate between two groups. However, compared with those of conventional group, patients in acupotomy group had significantly less bleeding, earlier healing of fissure and less pain. Conclusion: The results suggest that acupotomy treatment of anal fissure with anal sphincterotomy is a better therapeutic technique with advantages of easier manipulation, earlier healing and milder wound, less infectious complications and pain.