Korean J Gastrointest Endosc.  2006 Mar;32(3):184-189.

Endoscopic Sphincterotomy Plus Endoscopic Papillary Large Balloon Dilatation for Large Bile Duct Stones

  • 1Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea. dklee@yumc.yonsei.ac.kr
  • 2Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea.


BACKGROUND/AIMS: The extraction of large common bile duct (CBD) stones after an endoscopic sphincterotomy (EST) is successful in 80~90% of cases but it often requires a prolonged time and repeated trials. This study investigated the utility of a combined endoscopic papillary large balloon dilatation (EPLBD) and a mid-incision of an EST (m-EST) method for the removal of large CBD stones.
Thirty patients with large CBD stones were enrolled in this study. EPLBD was carried out using the one-step inflation of a 15~18 mm diameter balloon after m-EST.
The maximum stone diameter was 21.62+/-5.38 mm. Twelve patients had more than 4 stones, 7 patients had 2 stones, and the remainder had a single large stone. Complete ductal clearance was achieved in all patients. After the procedure, the serum amylase and/or lipase levels were elevated in 3 patients (13.3%). However, there was no episode of true pancreatitis. Minor bleeding was encountered in only one patient (3.3%), and was easily controlled by an endoscopic epinephrine injection. The procedure was carried out safely in 6 patients with periampullary diverticulum. No perforation or mortality was encountered.
Combined EPLBD and m-EST is a safe and effective method, and may be a good alternative treatment for removing large CBD stones.


Choledocholithiasis; Endoscopic sphincterotomy; Endoscopic papillary balloon dilatation
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