Endoscopic papillary large balloon dilation vs endoscopic sphincterotomy for retrieval of common bile duct stones:A meta-analysis

AIM: To compare the efficacy and safety of endoscopic papillary large balloon dilation (EPLBD) with endoscopic sphincterotomy (EST) in retrieval of common bile duct stones (≥ 10 mm).

Endoscopic papillary large balloon dilation alone or combined with small or complete sphincterotomy for the removal of large common bile duct stones

Background:Endoscopic papillary large balloon dilation(EPLBD)has been proposed as an alternative to manage large bile duct stones.However,EPLBD alone or combined with sphincterotomy remains controversial.Methods:Between Jan.2014 and Dec.2017,195 consecutive patients with proven large common bile duct stones(size≥10 mm)were retrospectively analyzed.We compared the baseline characteristics,procedure time,success rate of stone removal and morbidity outcomes in different groups.Results:There were no significant difference between baseline characteristics of the groups compared.A total of 89.2%,95.4%,and 93.8% of the patients in the EPLBD,EPLBD+small sphincterotomy(SES),and EPLBD+complete sphincterotomy(CES)groups had stones cleared(P=0.473),respectively.There was no difference in terms of procedure time(33.5±10.2,34.8±9.0,34.9±8.2,in the EPLBD,EPLBD+SES,and EPLBD+CES groups,respectively).However,when assigned to tvvo groups according to bile duct stones diameter(bile duct stones<13 mm,bile duct stones≥13 mm).in the bile duct stones<13 mm group,the procedure time was significantly less in the EPLBD group than the EPLBD+SES group and the EPLBD+CES group(P=0.028).In the bile duct stones≥13 mm group,the mechanical lithotripsy rate of EPLBD was significantly higher compared to EPLBD+SES or EPLBD+CES(P=0.032).The complication rates were similar among all groups.Conclusions:The diameter of bile duct stones should be taken into consideration when choosing EPLBD alone or combined with small sphincterotomy for the removal of common bile duct stones.

Reappraisal of endoscopic papillary balloon dilation for the management of common bile duct stones

Although endoscopic sphincterotomy(EST) is still considered as a gold standard treatment for common bile duct(CBD) stones in western guideline, endoscopic papillary balloon dilation(EPBD) is commonly used by the endoscopists in Asia as the first-line treatment for CBD stones. Besides the advantages of a technical easy procedure, endoscopic papillary large balloon dilation(EPLBD) can facilitate the removal of large CBD stones.The indication of EPBD is now extended from removal of the small stones by using traditional balloon, to removal of large stones and avoidance of lithotripsy by using large balloon alone or after EST. According to the reports of antegrade papillary balloon dilatation, balloon dilation itself is not the cause of pancreatitis. On the contrary, adequate dilation of papillary orifice can reduce the trauma to the papilla and pancreas by the basket or lithotripter during the procedure of stone extraction. EPLBD alone is as effective as EPLBD with limited EST. Longer ballooning time may be beneficial in EPLBD alone to achieve adequate loosening of papillary orifice. The longer ballooning time does not increase the risk of pancreatitis but may reduce the bleeding episodes in patients with coagulopathy. Slowly inflation of the balloon, but not exceed the diameter of bile duct and tolerance of the patients are important to prevent the complication of perforation. EPBLD alone or with EST are not the sphincter preserved procedures, regular follow up is necessary for early detection and management of CBD stones recurrence.

Primary large cell neuroendocrine carcinoma in the common bile duct:First Asian case report

Large cell neuroendocrine carcinoma (LCNEC) in the biliary system is a poorly differentiated, high-grade neuroendocrine tumor. These tumors exhibit aggressive behavior and an increased tendency for early nodal and distant metastases. Herein, we report an unusual case of a pure primary LCNEC of the common bile duct (CBD). A 75-year-old female presented with nausea and jaundice. The patient underwent a CBD excision with lymph node dissection. Upon histological and immunohistochemical examination, the tumor exhibited pure large cell-type neuroendocrine features. Metastases were noted in two of the eight lymph nodes. The patient was administered adjuvant chemotherapy. The patient&#x02019;s cancer recurred 7 mo after surgery, and the patient died from liver failure 5 mo after recurrence. The prognosis of LCNEC of CBD remains poor despite curative resection and adjuvant chemotherapy. The role of additional therapies, such as multimodal treatment including radiation therapy, must be further studied to improve the prognoses of patients.

Innovation of endoscopic management in difficult common bile duct stone in the era of laparoscopic surgery

Common bile duct(CBD)stone is a common biliary problem,which often requires endoscopic approach as the initial treatment option.Roughly,7%-12%of the subjects who experience cholecystectomy were subsequently referred to biliary endoscopist for further management.In general,there are three classifications of difficult CBD stone,which are based on the characteristics of the stone(larger than 15 mm,barrel or square-shaped stones,and hard consistency),accessibility to papilla related to anatomical variations,and other clinical conditions or comorbidities of the patients.Currently,endoscopic papillary large balloon dilation(EPLBD)of a previous sphincterotomy and EPLBD combined with limited sphincterotomy performed on the same session is still recommended by the European Society of Gastrointestinal Endoscopy as the main approach in difficult CBD stones with history of failed sphincterotomy and balloon and/or basket attempts.If failed extraction is still encountered,mechanical lithotripsy or cholangioscopy-assisted lithotripsy or extracorporeal shockwave lithotripsy can be considered.Surgical approach can be considered when stone extraction is still failed or the facilities to perform lithotripsy are not available.To our knowledge,conflicting evidence are still found from previous studies related to the comparison between endoscopic and surgical approaches.The availability of experienced operator and resources needs to be considered in creating individualized treatment strategies for managing difficult biliary stones.

Should we redefi ne large common bile duct stone?

The definition of large stones is not clear ranging from 10 mm to 15 mm and does not include the lower common bile duct (CBD) diameter. Three hundred and four patients who underwent endoscopic retrograde cholangiopancreatography and stone extraction were retrospectively analyzed over a 1-year period. Sixteen patients were different from others in that 10 patients with large stones had stone extraction with a wire basket or a balloon catheter and 6 patients with small stones had stone extraction with mechanical lithotripsy. The defi nition of large stones should include diameter of the lower CBD and any stone in lower CBD with its diameter greater than 2 mm.

Failure of sequential biliary stenting for unsuccessful common bile duct stone removal

AIM: To determine the factors associated with the failure of stone removal by a biliary stenting strategy. METHODS: We retrospectively reviewed 645 patients with common bile duct (CBD) stones who underwent endoscopic retrograde cholangiography for stone removal in Siriraj GI Endoscopy center, Siriraj Hospital from June 2009 to June 2012. A total of 42 patients with unsuccessful initial removal of large CBD stones that underwent sequential biliary stenting were enrolled in the present study. The demographic data, laboratory results, stone characteristics, procedure details, and clinical outcomes were recorded and analyzed. In addition, the patients were classified into two groups based on outcome, successful or failed sequential biliary stenting, and the above factors were compared. RESULTS: Among the initial 42 patients with unsuccessful initial removal of large CBD stones, there were 37 successful biliary stenting cases and five failed cases. Complete CBD clearance was achieved in 88.0% of cases. The average number of sessions needed beforecomplete stone removal was achieved was 2.43 at an average of 25 wk after the first procedure. Complications during the follow-up period occurred in 19.1% of cases, comprising ascending cholangitis (14.3%) and pancreatitis (4.8%). The factors associated with failure of complete CBD stone clearance in the biliary stenting group were unchanged CBD stone size after the first biliary stenting attempt (10.2 wk) and a greater number of endoscopic retrograde cholangio-pancreatography sessions performed (4.2 sessions). CONCLUSION: The sequential biliary stenting is an effective management strategy for the failure of initial large CBD stone removal.

Effect of ESBD on immune function, stress, blood amylase and urinary trypsinogen-2 in patients with common bile duct stones

Objective:To investigate the effects of endoscopic small sphincterotomy and balloon dilatation (ESBD) on immune function, stress, serum amylase and urinary trypsinogen-2 levels in patients with common bile duct stones.Methods: The clinical data of 150 patients with common bile duct stones admitted to Wuxi people's Hospital affiliated to Nanjing Medical University from January 2015 to December 2017 were retrospectively analyzed. According to the different surgical methods, the study group and the control group were divided into 75 cases. The study group was treated with ESBD, and the control group was treated with endoscopic sphincterotomy (EST). The changes of inflammation [high mobility group protein B1 (HMGB1), glycoprotein antigen 19-9 (CA19-9) and procalcitonin (PCT)] and stress response [C peptide (C-P), natural killer cell (NK) and cortisol (Cor)], blood amylase (AMS) and trypsinogen-2 (Try-2) were compared between the two groups.Results: The levels of C-P, NK and Cor, the HMGB1, CA19-9 and PCT, and the AMS and Try-2 in two groups before the operation were not significant difference (P>0.05). The levels of NK, CA19-9 was significantly decreased and C-P, Cor, HMGB1, PCT, AMS and Try-2 were significantly increased in both groups after operation (P<0.05). The levels of CP and Cor levels in the study group were (1.16±0.13) nmol/L and (150.23±15.12) nmol/L, respectively, which were lower than the control group (P<0.05). The levels of NK was (25.27±2.39)%, which were higher than the control group (P<0.05). The HMGB1, CA19-9 and PCT levels in the study group were (12.02±1.10) μg/L, (20.31±2.26) U/mL and (5.33±0.53) μg/L, respectively, which were lower than the control group (P<0.05). The AMS and Try-2 levels in the study group were (250.02±25.20) U/L and (36.11±3.51) ng/mL, respectively, which were lower than the control group (P<0.05).Conclusion: ESBD can effectively alleviate inflammatory reaction and stress response, and has little effect on blood amylase and urinary trypsin-2 in patients with common bile duct stones, which is worthy of clinical promotion.

Endoscopic papillary large balloon dilatation with sphincterotomy is safe and effective for biliary stone removal independent of timing and size of sphincterotomy

AIM To describe the efficacy and safety of endoscopic papillary large balloon dilatation(EPLBD) in the management of bile duct stones in a Western population. METHODS Data was collected from the endoscopic retrograde cholangiopancreatography(ERCP) and Radiology electronic database along with a review of case notes over a period of six years from 1 st August 2009 to 31 st July 2015 and incorporated into Microsoft excel. Statistical analyses were performed using Med Calc for Windows,version 12.5(Med Calc Software,Ostend,Belgium). Simple statistical applications were applied in order to determine whether significant differences exist in comparison groups. We initially used simple proportions to describe the study populations. Furthermore,we used chi-square test to compare proportions and categorical variables. Non-parametric Mann-Whitney U-test was applied in order to compare continuous variables. All comparisons were deemed to be statistically significant if P values were less than 0.05.RESULTS EPLBD was performed in 229 patients(46 females) with mean age of 68 ± 14.3 years. 115/229(50%) patients had failed duct clearance at previous ERCP referred from elsewhere with standard techniques. Duct clearance at the Index* ERCP(1 st ERCP at our centre) was 72.5%. Final duct clearance rate was 98%. EPLBD after fresh sphincterotomy was performed in 81(35.4%). Median balloon size was 13.5 mm(10-18). In addition to EPLBD,per-oral cholangioscopy(POC) and electrohydraulic lithotripsy(EHL) was performed in 35(15%) patients at index* ERCP. 63(27.5%) required repeat ERCP for stone clearance. 28(44.5%) required POC and EHL and 11(17.4%) had repeat EPLBD for complete duct clearance. Larger stone size(12.4 mm vs 17.4 mm,P < 0.000001),multiple stones(2,range(1-13) vs 3,range(1-12),P < 0.006) and dilated common bile duct(CBD)(12.4 mm vs 18.3 mm,P < 0.001) were significant predictors of failed duct clearance at index ERCP. 47 patients(20%) had ampullary or peri-ampullary diverticula. Procedure related adverse events included 2 cases of bleeding and pancreatitis(0.87%) each.CONCLUSION EPLBD is a safe and effective technique for CBDS removal. There is no difference in outcomes whether it is performed at the time of sphincterotomy or at a later procedure or whether there is a full or limited sphincterotomy.

内镜下十二指肠乳头括约肌小切开联合大球囊扩张术与内镜下十二指肠乳头括约肌切开术治疗胆总管结石的远期疗效分析

目的 比较内镜下十二指肠乳头括约肌小切开联合大球囊扩张术(ESLBD)(12~15 mm)与内镜下十二指肠乳头括约肌切开术(EST)治疗难治性胆总管结石的远期疗效。方法 选择2009年1月至2020年1月在上海交通大学医学院附属瑞金医院和上海中医药大学附属曙光医院消化内镜中心采用EST或ESLBD(12~15 mm)治疗的131例难治性胆总管结石患者,分为EST组(n=70)和ESLBD组(n=61),比较2组的完全取石成功率、经内镜逆行胰胆管造影术(ERCP)相关术后近期并发症及远期并发症发生率等指标。结果 EST组和ESLBD组的取石成功率和机械碎石率差异均无统计学意义(98.6%比100.0%,24.3%比18.0%,P均>0.05)。EST组的ERCP术后近期并发症发生率高于ESLBD组(8.6%比3.3%),但差异无统计学意义(P>0.05)。长期随访结果显示,EST组和ESLBD组的ERCP术后远期并发症发生率差异无统计学意义(11.9%比8.6%,P>0.05)。结论 与EST相比,ESLBD(12~15 mm)用于治疗难治性胆总管结石是安全有效的,尤其是对于合并十二指肠乳头旁憩室、凝血功能障碍等患者,ESLBD可作为首选治疗方法。EST与ESLBD的术后远期并发症发生率相似,ESLBD也会造成十二指肠乳头括约肌功能损伤。

SpyGlass DS系统联合激光碎石法与常规分次治疗胆总管大结石的效果和安全性的对比分析

目的比较SpyGlass DS系统激光碎石治疗术与内镜逆行胰胆管造影术(ERCP)下常规分次治疗胆总管大结石的安全性和有效性。方法选取2021年11月-2023年10月该院行ERCP,术中提示胆总管大结石的患者(>2 cm)38例,分为实验组(n=18)和对照组(n=20),实验组使用SpyGlass DS系统联合激光碎石治疗,对照组使用分次治疗(第1次放入胆管支架,3个月后再次行常规ERCP下胆总管结石取出术)。比较两组患者术后结石清除成功率和ERCP术后并发症发生率;手术3个月后随访,并复查磁共振胆胰管成像(MRCP),以明确是否有胆总管残余结石。结果实验组手术时间长于对照组,差异有统计学意义(P<0.05)。两组患者取石成功率和近期并发症发生率比较,差异均无统计学意义(P>0.05),实验组远期并发症发生率低于对照组,但差异无统计学意义(P=0.090)。结论由SpyGlass DS引导的激光碎石术治疗胆总管大结石的疗效确切,安全性高,术后结石复发率低。

Endoscopic papillary balloon dilation:Revival of the old technique

Radiologists first described the removal of bile duct stones using balloon dilation in the early 1980s.Recently,there has been renewed interest in endoscopic balloon dilation with a small balloon to avoid the complications of endoscopic sphincterotomy(EST)in young patients undergoing laparoscopic cholecystectomy.However,there is a disparity in using endoscopic balloon papillary dilation(EPBD)between the East and the West,depending on the origin of the studies.In the early 2000s,EST followed by endoscopic balloon dilation with a large balloon was introduced to treat large or difficult biliary stones.Endoscopic balloon dilation with a large balloon has generally been recognized as an effective and safe method,unlike EPBD.However,fatal complications have occurred in patients with endoscopic papillary large balloon dilation(EPLBD).The safety of endoscopic balloon dilation is still a debatable issue.Moreover,guidelines of indications and techniques have not been established in performing endoscopic balloon dilation with a small balloon or a large balloon.In this article,we discuss the issue of conventional and large balloon endoscopic dilation.We also suggest the indications and optimal techniques of EPBD and EPLBD.

Is endoscopic papillary large balloon dilatation without endoscopic sphincterotomy effective?

AIM: To evaluate the safety and efficacy of endoscopic papillary large balloon dilatation(EPLBD) without endoscopic sphincterotomy in a prospective study.METHODS: From July 2011 to August 2013, we performed EPLBD on 41 patients with nae papillae prospectively. For sphincteroplasty of EPLBD,endoscopic sphincterotomy(EST) was not performed,and balloon diameter selection was based on the distal common bile duct diameter. The balloon was inflated to the desired pressure. If the balloon waist did not disappear, and the desired pressure was satisfied, we judged the dilatation as complete. We used a retrieval balloon catheter or mechanical lithotripter(ML) to remove stones and assessed the rates of complete stone removal, number of sessions, use of ML and adverse events. Furthermore, we compared the presence or absence of balloon waist disappearance with clinical characteristics and endoscopic outcome.RESULTS: The mean diameters of the distal and maximum common bile duct were 13.5 ± 2.4 mm and16.4 ± 3.1 mm, respectively. The mean maximum transverse-diameter of the stones was 13.4 ± 3.4mm, and the mean number of stones was 3.0 ± 2.4.Complete stone removal was achieved in 97.5%(40/41)of cases, and ML was used in 12.2%(5/41) of cases.The mean number of sessions required was 1.2 ± 0.62.Pancreatitis developed in two patients and perforation in one. The rate of balloon waist disappearance was73.1%(30/41). No significant differences were noted in procedure time, rate of complete stone removal(100% vs 100%), number of sessions(1.1 vs 1.3, P= 0.22), application of ML(13% vs 9%, P = 0.71),or occurrence of pancreatitis(3.3% vs 9.1%, P =0.45) between cases with and without balloon waist disappearance.CONCLUSION: EST before sphincteroplasty may be unnecessary in EPLBD. Further investigations are needed to verify the relationship between the presence or absence of balloon waist disappearance.

Balloon dilation itself may not be a major determinant of post-endoscopic retrograde cholangiopancreatography pancreatitis

Endoscopic retrograde cholangiopancreatography (ERCP) is the essential first modality for common bile duct (CBD) stone therapy. The conventional endoscopic treatment for CBD stones is stone removal after endoscopic sphincterotomy (EST). Stone removal after papillary stretching using balloon dilation instead of the conventional method has been widely adopted. There are many reports regarding endoscopic papillary balloon dilation (EPBD) utilizing a small balloon (&#x0003c; 10 mm) instead of EST for the removal of small CBD stones. In contrast, two cases of mortality due to post-ERCP pancreatitis (PEP) were reported after an EPBD clinical trial in the Western world, and the psychological barrier caused by these incidences hinders the use of this technique in Western countries. Endoscopic papillar large balloon dilation (EPLBD), which is used to treat large CBD stones, was not widely adopted when first introduced due to concerns about perforation and severe pancreatitis from the use of a large balloon (12-20 mm). However, as experience with this procedure accumulates, the occurrence of PEP with EPLBD is confirmed to be much lower than with EPBD. This report reviews whether EPBD and EPLBD, two procedures that use balloon dilation but differ in terms of indications and concept, contribute to the occurrence of PEP.

胆道双塑料支架联合熊去氧胆酸对困难胆总管巨大结石的临床疗效

目的回顾性分析胆道双塑料支架置入联合熊去氧胆酸(UDCA)对困难胆总管巨大结石(≥15 mm)的临床疗效。方法收集我院2018年1月至2019年12月困难胆总管巨大结石患者63例,均通过内镜下逆行胰胆管造影(ERCP)放置胆道双塑料支架,其中32例患者术后联合UDCA 15 mg/(kg·d)口服(观察组),疗程3个月;31例患者未予口服药物(对照组)。3个月后拔除支架并行取石术,比较两组间第二次ERCP术前腹痛腹胀、肝功能异常、胆管炎、支架梗阻发生率、最大结石直径变化及取石成功率的差异。结果所有患者ERCP均取得成功,两次ERCP均未发生消化道出血、穿孔、重症急性胰腺炎等重大并发症。观察组第二次ERCP术前腹痛腹胀、肝功能异常、胆管炎及术中支架梗阻发生率分别为6.3%(2/32)、18.8%(6/32)、3.1%(1/32)、15.6%(5/32),均明显低于对照组25.8%(8/31)、45.2%(14/31)、22.6%(7/31)、38.7%(12/31),差异均有统计学意义(χ2=4.510、5.069、5.376、4.259,P=0.043、0.024、0.026、0.039)。观察组两次ERCP最大胆总管结石直径中位数分别为17、12 mm;对照组分别为17、15 mm,均较首次ERCP有明显缩小,差异均有统计学意义(Z=4.659、4.736,均P<0.01)。观察组最大胆总管结石直径降低均值较对照组更为显著(Z=3.883,P<0.001);二次ERCP取石成功率观察组为90.6%(29/32)、明显高于对照组71.0%(22/31),差异有统计学意义(χ2=3.946,P=0.047)。结论困难胆总管巨大结石患者放置胆道双塑料支架配合UDCA可更有效降低再次ERCP术前腹痛腹胀、肝功能异常、胆管炎及支架梗阻的发生率,降低最大结石直径,提高取石成功率。

ERCP途径治疗高龄患者胆总管巨大结石的临床护理研究

目的探讨经内镜(ERCP途径)治疗高龄患者胆总管巨大结石的可行性和护理操作配合。方法 40例高龄胆总管巨大结石患者完善术前准备,在密切监护下经十二指肠镜先行内镜下逆行胰胆管造影术(ERCP),发现胆总管结石后行内镜下十二指肠乳头括约肌切开术(EST)和机械碎石术(EML)取石,视具体情况留置鼻胆管引流。结果 38例取石成功,取石成功率95.0%,有11例行鼻胆管引流。乳头肌切口创面轻度渗血4例,一过性高淀粉酶血症9例,未发生严重并发症和死亡。结论 ERCP途径(EST联合EML)治疗高龄患者胆总管巨大结石安全有效,娴熟的内镜操作技术、专科护士精心的术前准备、准确迅速的术中配合和监护,以及完善的术后护理是保证治疗成功的重要条件。

EPLBD不同扩张时间治疗胆总管结石的效果

目的:探讨内镜下十二指肠乳头大球囊扩张术(endoscopic papillary large balloon dilation,EPLBD)不同球囊扩张时间治疗胆总管结石的有效性与安全性.方法:2012-08/2013-09采取EPLBD进行经内镜逆行性胰胆管造影术(endoscopic retrogradecholangiopancreatography,ERCP)治疗的胆总管结石患者90例,随机分3组:0 min组、1 min组、5 min组,球囊扩张时间分别为0 min、1min、5 min,比较3组患者取石成功率、机械碎石使用率、操作时间及近期并发症情况.结果:90例患者中有1例因无法忍受扩张疼痛而放弃继续扩张,共有89例患者入选,均顺利完成取石或碎石取石术.结石取净成功率均为100%,机械碎石使用率分别为0 min组14.8%(4/27),1 min组6.3%(2/32),5 min组20%(6/30)(P=0.25).操作时间分别为0 min组:29.5 min±8.62 min,1 min组:24.3 min±6.27min,5 min组:28.6 min±7.58 min(P=0.02).三组患者术中及术后无出血、穿孔、胆道感染及急性胰腺炎等近期并发症,高淀粉酶血症发生率分别为0 min组14.8%(4/27),1 min组0%(0/32),5 min组10%(3/30)(P=0.03).结论:EPLBD不同球囊扩张维持时间治疗胆总管结石均安全有效,1 min的扩张维持时间疗效较好.

高龄患者胆总管巨大结石的内镜治疗

目的探讨内镜对高龄患者胆总管巨大结石的可行性和疗效。方法 29例高龄胆总管巨大结石患者完善术前准备,在密切监护下经十二指肠镜先行内镜下逆行胰胆管造影术(ERCP),胆总管显影发现结石,均给予内镜下括约肌切开术(EST)和机械碎石术(EML)取石。根据具体情况,留置鼻胆管引流。结果 28例取石成功,取石成功率96.6%,有11例行鼻胆管引流。乳头肌切口创面轻度渗血3例,一过性高淀粉酶血症8例,未发生严重并发症和死亡。结论 EST联合EML治疗高龄患者胆总管巨大结石安全有效,但娴熟的内镜操作技术、精心的术前准备及术中的仔细监护和处理是保证操作成功的重要条件。

延长球囊扩张时间治疗胆总管结石的疗效观察

目的本研究旨在比较十二指肠乳头切开联合大球囊扩张1~3 min球囊扩张持续时间与低于1 min持续时间治疗胆总管结石患者的疗效及并发症发生率。方法分析行十二指肠乳头小切开联合大球囊扩张操作的768例胆总管结石患者的临床资料,根据球囊扩张持续时间不同(1~3 min VS<1 min)分为短时扩张组与延时扩张组,分析两组患者一般资料,插管时间、手术时间、完整取石率、机械碎石率、并发症发生率(术后胰腺炎发生率、出血发生率、感染发生率、穿孔发生率)。结果短时扩张组与延时扩张组患者一般资料、插管时间、手术时间、完整取石率、机械碎石率,两组比较差异无统计学意义,延时扩张组较短时扩张组出血发生率(P=0.032)和术后胰腺炎(P=0.028)发生率较低,差异有统计学意义。结论十二指肠乳头括约肌小切开联合大球囊延时扩张治疗胆总管结石术后胰腺炎及出血发生率更低,值得临床推广及进一步应用研究。

内镜机械碎石治疗胆总管大结石

目的探讨内镜治疗胆总管大结石机械碎石术成功率及结石复发率。方法采用经内镜机械碎石术治疗115例CBD大结石(≥2.0cm),并与同期388例非大结石病例(对照组)对比结石清除率和复发率。结果大结石组88例结石最大径为2.0cm～2.9cm,27例≥3.0cm;对照组150例结石<1.0cm,238例1.0cm～1.9cm。大结石组结石清除率(98.3%)与对照组(99.5%)无显著差异,平均操作例次(2.3次),明显多于对照组(1.4次)。平均随访72.1个月,大结石组结石复发率(16.1%)与对照组(6.1%)有显著差异(P<0.05),平均复发时间分别为18.7个月和24.8个月(P>0.05)。大结石组和对照组结石复发病例中,伴胆囊结石和行胆囊切除者分别占60%和80%,两者无显著差异(P>0.05)。结论EML治疗CBD大结石操作有一定难度,但结石清除率与对照组无显著差异,复发率显著高于对照组,结石>2.0cm复发率高,伴有胆囊结石与既往胆囊切除之间复发率无显著差异。