| Theme |
Treatment of Choledocholithiasis |
| Title |
Removal of Bile Duct Stones with Endoscopic Papillary Large Balloon Dilation |
| Author |
Mitsuhiro Kida |
Department of Gastroenterology, Kitasato University School of Medicine |
| Author |
Yusuke Kawaguchi |
Department of Gastroenterology, Kitasato University School of Medicine |
| Author |
Rikiya Hasegawa |
Department of Gastroenterology, Kitasato University School of Medicine |
| Author |
Eiji Miyata |
Department of Gastroenterology, Kitasato University School of Medicine |
| Author |
Toru Kaneko |
Department of Gastroenterology, Kitasato University School of Medicine |
| Author |
Hiroshi Yamauchi |
Department of Gastroenterology, Kitasato University School of Medicine |
| Author |
Kosuke Okuwaki |
Department of Gastroenterology, Kitasato University School of Medicine |
| Author |
Tomohisa Iwai |
Department of Gastroenterology, Kitasato University School of Medicine |
| Author |
Hiroshi Imaizumi |
Department of Gastroenterology, Kitasato University School of Medicine |
| [ Summary ] |
The use of endoscopic papillary large balloon dilation (EPLBD) for removal of difficult bile duct stones was reported in 2003 ; it involved use of large balloons (12‒20 mm diameter), which were inserted and dilated for 30 seconds, after which bile duct stones were removed in a basket. EPLBD is indicated for bile duct stones larger than 10 mm in diameter and contraindicated in patients at risk of bleeding, including those on anticoagulant agents and with distal bile duct stenosis. In general, the initial stone removal rate was 84.0 % and the total removal rate was 96.5 % by 1.20 times of endoscopic treatment, on average. Mechanical lithotripsy was applied in 14.1 % of patients. Complication rate was 8.3 %, including pancreatitis in 2.4 %, bleeding in 3.6 %, perforation in 0.6 %, miscellaneous in 0.2 %, and mortality in 0.2 % of patients, respectively. The success rate of the stone removal and the rate of subsequent complications was likely to be nearly the same, except for EPLBD is superior to large stones more than 1.0‒1.5 cm. Recent reports indicate that EPLBD with or without preceding EST yields almost identical results． |