Late Complications and Stone Recurrence Rates after Bile Duct Stone Removal by Endoscopic Sphincterotomy and Large Balloon Dilation are Similar to Those after Endoscopic Sphincterotomy Alone

Ka Young Kim; Jimin Han; Ho Gak Kim; Byeong Suk Kim; Jin Tae Jung; Joong Goo Kwon; Eun Young Kim; Chang Hyeong Lee

doi:10.5946/ce.2013.46.6.637

Articles

Page Path: HOME > Clin Endosc > Volume 46(6); 2013 > Article

Original Article Late Complications and Stone Recurrence Rates after Bile Duct Stone Removal by Endoscopic Sphincterotomy and Large Balloon Dilation are Similar to Those after Endoscopic Sphincterotomy Alone: Ka Young Kim, Jimin Han, Ho Gak Kim, Byeong Suk Kim, Jin Tae Jung, Joong Goo Kwon, Eun Young Kim, Chang Hyeong Lee; Clinical Endoscopy 2013;46(6):637-642.
DOI: https://doi.org/10.5946/ce.2013.46.6.637
Published online: November 19, 2013

Department of Internal Medicine, Catholic University of Daegu School of Medicine, Daegu, Korea.

Correspondence: Jimin Han. Department of Internal Medicine, Catholic University of Daegu School of Medicine, 33 Duryugongwon-ro 17-gil, Nam-gu, Daegu 705-718, Korea. Tel: +82-53-650-3042, Fax: +82-53-624-3281, jmhan@cu.ac.kr

• Received: October 22, 2012 • Revised: December 5, 2012 • Accepted: January 9, 2013

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

8,062 Views
94 Download
41 Crossref
41 Scopus

prev next

Full Article

Download PDF

Abstract
INTRODUCTION
MATERIALS AND METHODS
RESULTS
DISCUSSION
Acknowledgments
Acknowledgments
NOTES
REFERENCES

Abstract

Background/Aims
Between endoscopic sphincterotomy (ES) alone and combined endoscopic sphincterotomy and large balloon dilation (ES-LBD) groups, efficacy and long-term complications, difference in biliary stone recurrence rate, and risk factors of stone recurrence were compared.
Methods
Medical records of 222 patients who underwent ERCP for biliary stone removal were retrospectively reviewed. Patients with dilated CBD ≥11 mm and follow-up longer than 6 months were included.
Results
There were 101 patients in ES-LBD group and 121 patients in ES group. Mean follow-up duration was 25.0 (6-48) months and 13.0 (6-43) months, respectively (p=0.001). There was no difference in number of ERCP sessions, brown pigment stones, angle between mid and distal common bile duct (CBD angle) <135°, and lithotripsy rate. Complete retrieval success rate was excellent in both groups (100% vs. 99%). Early complication rate of ES-LBD and ES alone group was 4 and 4.1%, respectively (p=1.000). One patient in ES-LBD group died from delayed bleeding. Late complication rate was 5.9 and 3.3%, respectively (p=1.000). Stone recurrence rate was 6.9% and 5.8%, respectively (p=0.984). The only Independent risk factor of stone recurrence was presence of periampullary diverticulum.
Conclusions
Late complication and stone recurrence rates were similar between ES-LBD and ES alone groups.
Keywords: Common bile duct stone; Sphincterotomy, endoscopic; Endoscopic large balloon dilation; Stone recurrence; Late complication

INTRODUCTION

Since the introduction of endoscopic sphincterotomy followed by endoscopic papillary balloon dilation (ES-EPBD) in 2003,1 immediate and acute complications of this procedure have been well studied.2,3 Long-term outcome after ES-EPBD with a ≤8 mm balloon is also known.4,5 However, long-term outcome after ES followed by large balloon dilation (ES-LBD, ≥12 mm) has not been established yet. Since the results of an ex vivo animal study showed that ES-LBD can damage the bile duct wall and cause potential impairment of sphincter of Oddi function and overdilation of extrahepatic bile ducts,6 long-term outcome after ES-LBD may be different from that of ES-EPBD using a balloon with smaller diameter. The aim of this study was to retrospectively compare ES alone and ES-LBD groups in regard to efficacy and late complications, difference in bile duct stone recurrence rate, and risk factors of stone recurrence.

MATERIALS AND METHODS

Patient selection

From December 2004 to March 2009, patients who underwent endoscopic retrograde cholangiopancreatography (ERCP) for bile duct stone removal were included if they met all of the following criteria: 1) age >18 years, 2) first trial of ERCP (virgin papilla), 3) dilated common bile duct (CBD) with a diameter of ≥11 mm on a cholangiogram, and 4) follow-up period of ≥6 months either by review of medical records or by phone calls. Patients were excluded if they met any of the following criteria: 1) previous ES, 2) precut or infundibulotomy, 3) previous Billroth II operation, or 4) uncorrected coagulopathy. All patients gave written informed consent before undergoing ERCP for bile duct stone removal.

Endoscopic procedures

All ERCP procedures were performed under conscious sedation after intravenous injection of midazolam and pethidine. An Olympus EVIS system, JF-V, or TJF 200 series (Olympus, Tokyo, Japan) was used for ERCP. A generator with an automatically controlled cutout system (Endocut mode) was used for all ES. Selective bile duct cannulation was performed, and cholangiogram was obtained. After the assessment of number and size of bile duct stones and diameter of the bile duct, either ES alone or ES-LBD was chosen at discretion of the endoscopist. A pull-type papillotome (Autotome RX44; Boston Scientific Corp., Natick, MA, USA) was used for sphincterotomy. In the ES-alone group, ES was performed up to the major horizontal fold of the major duodenal papilla. In the ES-LBD group, ES was performed up to the mid-portion of the major duodenal papilla. Then, a wire-guided balloon dilation catheter with a diameter of ≥12 mm was used for LBD (CRE™ Wireguided; Boston Scientific Corp., Natick, MA, USA). Bile duct stones were removed with a basket or a retrieval balloon. A mechanical lithotripter was used when stones could not be retrieved after either maximal ES (in the ES-alone group) or balloon dilation after ES (in the ES-LBD group). After removal of bile duct stones, a 7 Fr nasobiliary catheter (Nagaraja Nasal Biliary Drainage; Wilson-Cook Medical Inc., Winston-Salem, NC, USA) was placed. Cholangiogram through a nasobiliary catheter was obtained one or two days later.

Outcome parameters

The following parameters were assessed and compared between the two groups:

• Patient characteristics

• Bile duct stone characteristics: number, maximal diameter of the largest stone, type, requirement for lithotripsy

• Complication rate: bleeding, hyperamylasemia, pancreatitis, perforation

• Stone recurrence rate

• Risk factors of stone recurrence: CBD angle (Fig. 1), periampullary diverticulum, intrahepatic duct stone, common hepatic duct stricture, history of cholecystectomy, gallbladder stones left in situ, mechanical lithotripsy, CBD diameter after stone extraction

Definitions

Definitions of complications related to ES and ES-LBD were similar to those of Cotton et al.7 Minor bleeding was defined as a decrease of at least 2 g/dL in the hemoglobin concentration and achievement of hemostasis during the same procedure. Major bleeding was defined as interruption of the procedure, clinical evidence of bleeding such as melena or hematemesis with a decrease of at least 2 g/dL in hemoglobin concentration, or the need for at least two units of packed red blood cell transfusion. Delayed bleeding was defined as bleeding that developed after the procedure. Procedure-induced hyperamylasemia was defined as an increase in the serum amylase level ≥3 times that of the upper normal limit without pancreatic pain and normalized serum amylase level within 2 days. Procedure-induced pancreatitis was defined as the development of pancreatic pain with an increase in the serum amylase level ≥3 times that of the upper normal limit lasting over 2 days. Early complication was defined as complication that developed within 72 hours after the procedure and included bleeding, hyperamylasemia, post-ERCP pancreatitis, perforation, and death. Late complication was defined as complication that occurred more than 72 hours after the procedure and included recurrent cholangitis, biliary pancreatitis, bile duct stricture, and cholecystitis. CBD angle was defined as the first angulation from the ampullary orifice along the course of CBD, and measured on the cholangiogram (Fig. 1).8 Bile duct stone recurrence was defined as presence of biliary pain and abnormal liver function test results and/or bile duct stone detected on an abdominal computed tomography scan.

Statistical analysis

Statistical analysis was performed with SPSS version 14.0 software for Windows (SPSS Inc., Chicago, IL, USA). Values were presented as median with range. Potentially relevant risk factors were assessed by univariate analysis with the chi-square statistic for categorical variables and simple logistic regression for continuous variables. Significant factors (p<0.1) from univariate analysis were included in a forward, stepwise multiple logistic regression model to identify the risk factors for recurrent bile duct stones. A p<0.05 was considered statistically significant.

RESULTS

Patients

There were 101 patients in the ES-LBD group and 121 patients in the ES-alone group. Baseline characteristics of the patients are summarized in Table 1. There was no significant difference between the two groups except for age, presence of gallbladder stone and periampullary diverticulum, and follow-up duration.

Bile duct stones

Bile duct stones in the ES-LBD group were greater in number and larger in maximal diameter than those in the ES alone group (1.0 [1 to ≥5] vs. 2.0 [1 to ≥5], p=0.001; 10.0 [2 to 20] vs. 12.0 [3 to 25] mm, p=0.000, respectively). However, there was no significant difference between the ES-LBD and ES-alone groups regarding number of ERCP sessions for removal, number of patients with brown pigment stones, use of lithotripsy, and complete removal rate (1.0 [1 to 3] vs. 1.0 [1 to 4], p=0.149; 80 [79.2%] vs. 94 [75.2%], p=0.870; 25 [24.8%] vs. 33 [27.3%], p=0.759; 100 [99%] vs. 121 [100%], p=0.455, respectively).

Complications

Complications related to ES and ES-LBD are summarized in Table 2. The most common early complication in both groups was minor bleeding (15/121 vs. 15/101; p=0.580). One death occurred in the ES-LBD group from delayed major bleeding and rapid development of hypovolemic shock that did not respond to resuscitation and intervention. The most common late complication in both groups was recurrent cholangitis (2/121 vs. 4/101; p=0.413). Acute cholecystitis occurred in two patients of each group (p=1.000).

Bile duct stone recurrence

Bile duct stone recurred in seven patients from the ES-alone group and seven patients from the ES-LBD group (5.8% vs. 6.9%; p=0.786). Between the two groups, there was no significant difference in sex and age of the patients with bile duct stone recurrence (5 males vs. 2 males, p=0.286; 79.0 [46 to 83] years vs. 75.0 [51 to 87] years, p=0.932, respectively). Also, there was no significant difference in maximal bile duct diameter, maximal stone diameter, and number of bile duct stones (14.0 [10 to 17] mm vs. 14 [12 to 15] mm, p=0.788; 11.0 [6 to 15] mm vs. 14.0 [3 to 21] mm, p=0.289; 2.0 [1 to ≥5] vs. 5.0 [1 to ≥5], p=0.052, respectively). Presence of periampullary diverticulum was not different between the two groups (1/7 vs. 2/7; p=0.515). Mechanical lithotripsy was performed in three patients of the ES-alone group and five patients of the ES-LBD group (p=0.280). Patients with recurrent bile duct stones had gallbladder stones left in situ in two patients from the ES-alone group and two from the ES-LBD group (p=1.000). CBD angle did not show significant difference between patients with recurrent bile duct stones from the ES-alone and ES-LBD groups (<90°, 1 vs. 1, p=0.409; 90° to 135°, 3 vs. 4, p=1.000; 135° to 180°, 3 vs. 2, p=0.181, respectively). Time to recurrence and follow-up duration of patients with recurrent bile duct stones from each group did not show significant difference (16.0 [10 to 42] months vs. 14.0 [1 to 35] months, p=0.395; 36 [13 to 44] months vs. 20.0 [6 to 42] months, p=0.202, respectively).

Risk factors for bile duct stone recurrence

Because there was no significant difference between the ES-alone and ES-LBD groups in respect to potential risk factors for bile duct stone recurrence, risk factors for bile duct stone recurrence in the entire study subjects were investigated. In univariate analysis, the risk factors for bile duct stone recurrence were number of ERCP sessions to clear CBD stones, CBD angle of <135°, need for mechanical lithotripsy, and presence of periampullary diverticulum (Table 3). Multivariate analysis showed that presence of periampullary diverticulum was the only independent risk factor for bile duct stone recurrence (odds ratio, 7.85; 95% confidence interval, 1.68 to 36.69; p=0.009) (Table 4).

DISCUSSION

In this study, the long-term outcome of ES-LBD in patients with CBD stones was not significantly different from that of ES alone with regard to recurrent cholangitis, cholecystitis, and bile duct stone recurrence. This finding may be explained by possible permanent disruption of sphincter function by ES-LBD. Preservation of sphincter function is a well-known advantage of EPBD9,10 and has been the basis for lower rate of late biliary complications after EPBD. However, an ex vivo animal study demonstrated that balloons with diameters of ≥12 mm disrupt integrity of the bile duct wall and sphincter function.6 Because of differences between the ex vivo animal model and humans in clinical practice (i.e., compliance of the bile duct, thickness of the fibromuscular layer, and different anatomy), findings of the animal study may not be directly applicable to clinical practice.6 Nevertheless, irreversible loss of sphincter function by ES-LBD may result in duodenobiliary reflux similar to that by ES alone. This reflux of duodenal contents into the biliary system may be associated with bacterial colonization and can cause recurrent bile duct stones, ascending cholangitis, and acute cholecystitis.11 Also, long-term outcome of ES-LBD may have been affected by older age and greater prevalence of gallbladder stone and periampullary diverticulum in this group. Older age and periampullary diverticulum are known risk factors of bile duct stone recurrence.12,13 On the other hand, these factors may prompt the use of ES-LBD for stone removal. Gallbladder stone is a known risk factor for bile duct stone recurrence.14,15 Cholecystectomy is usually recommended to prevent bile duct stone recurrence. However, the bile duct stone recurrence rate did not differ between the ES-alone and ES-LBD groups with regard to the presence of gallbladder or gallbladder stones. This may result from predominance of brown pigment stones in the study subjects. Also, there have been concerns about papillary stricture in ES-LBD.16 In this study, there was no papillary stricture during the follow-up.

Bile duct stone recurrence rate after ES-LBD was 6.9%, which was similar to that of previous studies that evaluated ES-EPBD or EPBD alone.4,5,14 There was no significant difference in potential risk factors for bile duct stone recurrence between the ES alone and the ES-LBD group. Therefore, the risk factors for bile duct stone recurrence in the entire study subjects were evaluated. Multivariate analysis showed that presence of periampullary diverticulum was the only independent risk factor for bile duct stone recurrence. This finding was not much different from known risk factors. A previous study showed that the risk factors for CBD stone recurrence after ES only include older age, dilation of the CBD (≥13 mm), previous open or laparoscopic cholecystectomy, presence of periampullary diverticulum, and more acute CBD angulation (≤145°).17 Known risk factors for recurrent stones after ES and EPBD vary from study to study and include presence of a periampullary diverticulum, gallbladder stones left in situ, dilated CBD, previous cholecystectomy, no confirmation of a clean duct on intraductal ultrasonography, and mechanical lithotripsy.5,14,15,18 Risk factors for recurrent stones after ES-LBD are less well studied. One recent study reported that a dilated bile duct (≥22 mm) predicted stone recurrence in patients who underwent ES-LBD.19 Although acute CBD angle did not reach statistical significance in multivariate analysis, this may result in bile stasis and stone recurrence. The number of ERCP sessions needed to clear CBD stones implies multiplicity and difficulty in removing all the stones. To decrease the number of ERCP sessions needed to clear bile duct stones and prevent stone recurrence, intraductal ultrasonography, or direct peroral cholangioscopy may be useful for documenting the complete clearance of bile duct stones, but it is not universally available.20-22 On the other hand, the presence of periampullary diverticulum and an acute CBD angle are risk factors that cannot be modified. Still, these are useful in predicting bile duct stone recurrence and in educating patients at high risk.

Limitations of this study are its retrospective, single-center design and the small number of patients with bile duct stone recurrence. Further prospective, randomized controlled studies with a longer follow-up period and a greater number of patients are needed to overcome these limitations.

In conclusion, ES-LBD for bile duct stones showed similar complete stone removal rate, long-term complication rate, and stone recurrence rate compared with ES alone. The independent risk factor for stone recurrence was presence of periampullary diverticulum.

Acknowledgments

This study was supported by a grant from the Korea Ministry of Health and Welfare, Republic of Korea (project no. A084177).

The authors have no financial conflicts of interest.

REFERENCES

1. Ersoz G, Tekesin O, Ozutemiz AO, Gunsar F. Biliary sphincterotomy plus dilation with a large balloon for bile duct stones that are difficult to extract. Gastrointest Endosc 2003;57:156–159.Article PubMed
2. Stefanidis G, Viazis N, Pleskow D, et al. Large balloon dilation vs. mechanical lithotripsy for the management of large bile duct stones: a prospective randomized study. Am J Gastroenterol 2011;106:278–285.Article PubMed PDF
3. Youn YH, Lim HC, Jahng JH, et al. The increase in balloon size to over 15 mm does not affect the development of pancreatitis after endoscopic papillary large balloon dilatation for bile duct stone removal. Dig Dis Sci 2011;56:1572–1577.Article PubMed PMC
4. Yasuda I, Fujita N, Maguchi H, et al. Long-term outcomes after endoscopic sphincterotomy versus endoscopic papillary balloon dilation for bile duct stones. Gastrointest Endosc 2010;72:1185–1191.Article PubMed
5. Ohashi A, Tamada K, Wada S, et al. Risk factors for recurrent bile duct stones after endoscopic papillary balloon dilation: long-term follow-up study. Dig Endosc 2009;21:73–77.Article PubMed
6. Hisatomi K, Ohno A, Tabei K, Kubota K, Matsuhashi N. Effects of large-balloon dilation on the major duodenal papilla and the lower bile duct: histological evaluation by using an ex vivo adult porcine model. Gastrointest Endosc 2010;72:366–372.Article PubMed
7. Cotton PB, Lehman G, Vennes J, et al. Endoscopic sphincterotomy complications and their management: an attempt at consensus. Gastrointest Endosc 1991;37:383–393.Article PubMed
8. Kim HJ, Choi HS, Park JH, et al. Factors influencing the technical difficulty of endoscopic clearance of bile duct stones. Gastrointest Endosc 2007;66:1154–1160.Article PubMed
9. Yasuda I, Tomita E, Enya M, Kato T, Moriwaki H. Can endoscopic papillary balloon dilation really preserve sphincter of Oddi function? Gut 2001;49:686–691.Article PubMed PMC
10. Sato H, Kodama T, Takaaki J, et al. Endoscopic papillary balloon dilatation may preserve sphincter of Oddi function after common bile duct stone management: evaluation from the viewpoint of endoscopic manometry. Gut 1997;41:541–544.Article PubMed PMC
11. Tsujino T, Isayama H, Ito Y, et al. Long-term outcomes (mean follow-up period > 10 years) of endoscopic papillary balloon dilation for bile duct stones. Gastrointest Endosc 2008;67:AB163–AB164.Article
12. Keizman D, Shalom MI, Konikoff FM. An angulated common bile duct predisposes to recurrent symptomatic bile duct stones after endoscopic stone extraction. Surg Endosc 2006;20:1594–1599.Article PubMed
13. Ueno N, Ozawa Y, Aizawa T. Prognostic factors for recurrence of bile duct stones after endoscopic treatment by sphincter dilation. Gastrointest Endosc 2003;58:336–340.Article PubMed
14. Kojima Y, Nakagawa H, Miyata A, et al. Long-term prognosis of bile duct stones: endoscopic papillary balloon dilatation versus endoscopic sphincterotomy. Dig Endosc 2010;22:21–24.Article PubMed
15. Tsujino T, Kawabe T, Komatsu Y, et al. Endoscopic papillary balloon dilation for bile duct stone: immediate and long-term outcomes in 1000 patients. Clin Gastroenterol Hepatol 2007;5:130–137.Article PubMed
16. Lee JH. Is combination biliary sphincterotomy and balloon dilation a better option than either alone in endoscopic removal of large bileduct stones? Gastrointest Endosc 2007;66:727–729.Article PubMed
17. Keizman D, Ish Shalom M, Konikoff FM. Recurrent symptomatic common bile duct stones after endoscopic stone extraction in elderly patients. Gastrointest Endosc 2006;64:60–65.Article PubMed
18. Yasuda I. Management of the bile duct stone: current situation in Japan. Dig Endosc 2010;22(Suppl 1):S76–S78.Article PubMed
19. Kim KH, Rhu JH, Kim TN. Recurrence of bile duct stones after endoscopic papillary large balloon dilation combined with limited sphincterotomy: long-term follow-up study. Gut Liver 2012;6:107–112.Article PubMed PMC
20. Ang TL, Teo EK, Fock KM, Lyn Tan JY. Are there roles for intraductal US and saline solution irrigation in ensuring complete clearance of common bile duct stones? Gastrointest Endosc 2009;69:1276–1281.Article PubMed
21. Chen YK, Parsi MA, Binmoeller KF, et al. Single-operator cholangioscopy in patients requiring evaluation of bile duct disease or therapy of biliary stones (with videos). Gastrointest Endosc 2011;74:805–814.Article PubMed
22. Moon JH, Ko BM, Choi HJ, et al. Direct peroral cholangioscopy using an ultra-slim upper endoscope for the treatment of retained bile duct stones. Am J Gastroenterol 2009;104:2729–2733.Article PubMed PDF

Fig. 1

Measurement of the common bile duct angle. The first angulation from the ampullary orifice is measured on a cholangiogram obtained in the prone position.

Table 1

Baseline Characteristics of the Patients

Values are presented as median (range) or number (%).

ES, endoscopic sphincterotomy; LBD, large balloon dilation; ERCP, endoscopic retrograde cholangiopancreatography.

Table 2

Complications Related to Common Bile Duct Stone Removal and Bile Duct Stone Recurrence

Values are presented as number (%).

ES, endoscopic sphincterotomy; LBD, large balloon dilation.

^a)Cause of death was delayed major bleeding; ^b)Significant overall rate, excluding minor bleeding and hyperamylasemia.

Table 3

Univariate Analysis of the Risk Factors for Bile Duct Stone Recurrence

Values are presented as median (range) or number (%).

CI, confidence interval; ERCP, endoscopic retrograde cholangiopancreatography; CBD, common bile duct; ES, endoscopic sphincterotomy; LBD, large balloon dilation.

Table 4

Multivariate Analysis of the Risk Factors for Bile Duct Stone Recurrence

ERCP, endoscopic retrograde cholangiopancreatography; CBD, common bile duct.

Figure & Data

REFERENCES

Citations

Citations to this article as recorded by

Structural or functional abnormality of sphincter of Oddi: an important factor for the recurrence of choledocholithiasis after endoscopic treatment
Ye Yang, Zeying Zhao, Shuodong Wu, Dianbo Yao
Annals of Medicine.2025;[Epub] CrossRef
Recurrence of common bile duct stones after endoscopic clearance and its predictors: A systematic review
Marko Kozyk, Suprabhat Giri, Sidharth Harindranath, Manan Trivedi, Kateryna Strubchevska, Rakesh Kumar Barik, Sridhar Sundaram
DEN Open.2024;[Epub] CrossRef
Characterization of biliary and duodenal microbiota in patients with primary and recurrent choledocholithiasis
Fang Liu, Zi-Kai Wang, Ming-Yang Li, Xiu-li Zhang, Feng-Chun Cai, Xiang-Dong Wang, Xue-Feng Gao, Wen Li
Health Information Science and Systems.2024;[Epub] CrossRef
Biliary stents for active materials and surface modification: Recent advances and future perspectives
Yuechuan Li, Kunshan Yuan, Chengchen Deng, Hui Tang, Jinxuan Wang, Xiaozhen Dai, Bing Zhang, Ziru Sun, Guiying Ren, Haijun Zhang, Guixue Wang
Bioactive Materials.2024; 42: 587. CrossRef
Biofunctional coatings and drug-coated stents for restenosis therapy
Yanghui Wen, Yihuan Li, Rui Yang, Yunjie Chen, Yan Shen, Yi Liu, Xiaomei Liu, Botao Zhang, Hua Li
Materials Today Bio.2024; 29: 101259. CrossRef
Evidence-based clinical practice guidelines for cholelithiasis 2021
Naotaka Fujita, Ichiro Yasuda, Itaru Endo, Hiroyuki Isayama, Takuji Iwashita, Toshiharu Ueki, Kenichiro Uemura, Akiko Umezawa, Akio Katanuma, Yu Katayose, Yutaka Suzuki, Junichi Shoda, Toshio Tsuyuguchi, Toshifumi Wakai, Kazuo Inui, Michiaki Unno, Yoshifu
Journal of Gastroenterology.2023; 58(9): 801. CrossRef
Endoclip papillaplasty (ECPP) versus limited EST plus EPLBD for a decrease in recurrent choledocholithiasis: a prospective cohort study
Xiaofang Lu, Yingchun Wang, Wenzheng Liu, Yaopeng Zhang, Wei Zheng, Xiue Yan, Hong Chang, Yonghui Huang
Surgical Endoscopy.2023; 37(10): 7790. CrossRef
The Clinical Presentations of Liver Abscess Development After Endoscopic Retrograde Cholangiopancreatography with Choledocholithiasis: A 17-Year Follow-Up
An-Che Liu, Wei-Chen Tai, Shao-Ming Chiu, Fai-Meng Sou, Shih-Cheng Yang, Lung-Sheng Lu, Chung-Mou Kuo, Yi-Chun Chiu, Seng-Kee Chuah, Chih-Ming Liang, Cheng-Kun Wu
Infection and Drug Resistance.2023; Volume 16: 6167. CrossRef
Low insertion of cystic duct increases risk for common bile duct stone recurrence
Seong Ji Choi, Jai Hoon Yoon, Dong Hee Koh, Hang Lak Lee, Dae Won Jun, Ho Soon Choi
Surgical Endoscopy.2022; 36(5): 2786. CrossRef
New common bile duct morphological subtypes: Risk predictors of common bile duct stone recurrence
Xu Ji, Zhuo Yang, Shu-Ren Ma, Wen Jia, Qian Zhao, Lu Xu, Ying Kan, Yang Cao, Yao Wang, Bao-Jun Fan
World Journal of Gastrointestinal Surgery.2022; 14(3): 236. CrossRef
Endoscopic Papillary Large Balloon Dilation Reduces Further Recurrence in Patients With Recurrent Common Bile Duct Stones: A Randomized Controlled Trial
Xu Wang, Xiangping Wang, Hao Sun, Gui Ren, Biaoluo Wang, Shuhui Liang, Linhui Zhang, Xiaoyu Kang, Qin Tao, Xuegang Guo, Hui Luo, Yanglin Pan
American Journal of Gastroenterology.2022; 117(5): 740. CrossRef
Angle of covered self-expandable metallic stents after placement is a risk factor for recurrent biliary obstruction
Kojiro Tanoue, Hirotsugu Maruyama, Yuki Ishikawa-Kakiya, Yosuke Kinoshita, Kappei Hayashi, Masafumi Yamamura, Masaki Ominami, Yuji Nadatani, Shusei Fukunaga, Koji Otani, Shuhei Hosomi, Fumio Tanaka, Noriko Kamata, Yasuaki Nagami, Koichi Taira, Toshio Wata
World Journal of Hepatology.2022; 14(5): 992. CrossRef
Angle of covered self-expandable metallic stents after placement is a risk factor for recurrent biliary obstruction
Kojiro Tanoue, Hirotsugu Maruyama, Yuki Ishikawa-Kakiya, Yosuke Kinoshita, Kappei Hayashi, Masafumi Yamamura, Masaki Ominami, Yuji Nadatani, Shusei Fukunaga, Koji Otani, Shuhei Hosomi, Fumio Tanaka, Noriko Kamata, Yasuaki Nagami, Koichi Taira, Toshio Wata
World Journal of Hepatology.2022; 14(5): 993. CrossRef
Recent developments in antibacterial or antibiofilm compound coating for biliary stents
Tao Wu, Yan Yang, He Su, Yuanhui Gu, Quanming Ma, Yan Zhang
Colloids and Surfaces B: Biointerfaces.2022; 219: 112837. CrossRef
Effect of stent placement on stone recurrence and post-procedural cholangitis after endoscopic removal of common bile duct stones
Jung-Hye Choi, Tae-Yoon Lee, Young-Koog Cheon
The Korean Journal of Internal Medicine.2021; 36(Suppl 1): S27. CrossRef
Need to identify the risk factor for stone recurrence after common bile duct exploration
Kee-Hwan Kim
The Journal of Minimally Invasive Surgery.2021; 24(1): 8. CrossRef
Should Common Bile Duct Exploration for Choledocholithiasis Be a Specialist-Only Procedure?
Russell Hodgson, Daniel Heathcock, Chien-Tse Kao, Rosemary Seagar, Mark Tacey, Jiun Miin Lai, Tuck Leong Yong, Nezor Houli, David Bird
Journal of Laparoendoscopic & Advanced Surgical Techniques.2021; 31(7): 743. CrossRef
Increased Risk of Pyogenic Liver Abscess after Endoscopic Sphincterotomy for Treatment of Choledocholithiasis
Cheng-Kun Wu, Chien-Ning Hsu, Wei-Ru Cho, Shih-Cheng Yang, An-Che Liu, Wei-Chen Tai, Chen-Hsiang Lee, Yao-Hsu Yang, Seng-Kee Chuah, Chih-Ming Liang
Infection and Drug Resistance.2021; Volume 14: 2121. CrossRef
Long-term Outcomes of Endoscopic Papillary Large-balloon Dilation for Common Bile Duct Stones
Toji Murabayashi, Yoshihide Kanno, Shinsuke Koshita, Takahisa Ogawa, Hiroaki Kusunose, Toshitaka Sakai, Kaori Masu, Keisuke Yonamine, Kazuaki Miyamoto, Fumisato Kozakai, Kazuki Endo, Yutaka Noda, Kei Ito
Internal Medicine.2020; 59(7): 891. CrossRef
Clinical significance of different periampullary diverticulum classifications for endoscopic retrograde cholangiopancreatography cannulation
Ping Yue, Ke-Xiang Zhu, Hai-Ping Wang, Wen-Bo Meng, Jian-Kang Liu, Lei Zhang, Xiao-Liang Zhu, Hui Zhang, Long Miao, Zheng-Feng Wang, Wen-Ce Zhou, Azumi Suzuki, Kiyohito Tanaka, Xun Li
World Journal of Gastroenterology.2020; 26(19): 2402. CrossRef
Clinical significance of different periampullary diverticulum classifications for endoscopic retrograde cholangiopancreatography cannulation
Ping Yue, Ke-Xiang Zhu, Hai-Ping Wang, Wen-Bo Meng, Jian-Kang Liu, Lei Zhang, Xiao-Liang Zhu, Hui Zhang, Long Miao, Zheng-Feng Wang, Wen-Ce Zhou, Azumi Suzuki, Kiyohito Tanaka, Xun Li
World Journal of Gastroenterology.2020; 26(19): 2403. CrossRef
Laparoscopic and endoscopic cooperative surgery for cholecystogastric fistula: A case report
Goshi Fujimoto
International Journal of Surgery Case Reports.2020; 71: 116. CrossRef
Risk factors of stone recurrence after endoscopic retrograde cholangiopancreatography for common bile duct stones
Peng Lujian, Cheng Xianneng, Zhang Lei
Medicine.2020; 99(27): e20412. CrossRef
Novel risk factors for recurrent biliary obstruction and pancreatitis after metallic stent placement in pancreatic cancer
Tsuyoshi Takeda, Takashi Sasaki, Takafumi Mie, Takaaki Furukawa, Ryo Kanata, Akiyoshi Kasuga, Masato Matsuyama, Masato Ozaka, Naoki Sasahira
Endoscopy International Open.2020; 08(11): E1603. CrossRef
Clinical Impact of Common Bile Duct Angulation for Recurrence of Bile Duct Stones
Se Woo Park
The Korean Journal of Gastroenterology.2020; 76(4): 177. CrossRef
Clinical Impact of Common Bile Duct Angulation on the Recurrence of Common Bile Duct Stone: A Meta-analysis and Review
Seongyul Ryu, Ik Hyun Jo, Seonhoo Kim, Yeon-Ji Kim, Woo Chul Chung
The Korean Journal of Gastroenterology.2020; 76(4): 199. CrossRef
Best Procedure for the Management of Common Bile Duct Stones via the Papilla: Literature Review and Analysis of Procedural Efficacy and Safety
Shigeto Ishii, Hiroyuki Isayama, Mako Ushio, Sho Takahashi, Wataru Yamagata, Yusuke Takasaki, Akinori Suzuki, Kazushige Ochiai, Ko Tomishima, Ryo Kanazawa, Hiroaki Saito, Toshio Fujisawa, Shuichiro Shiina
Journal of Clinical Medicine.2020; 9(12): 3808. CrossRef
Presence of Periampullary Diverticulum is Not a Hurdle to Successful Endoscopic Retrograde Cholangiopancreatography
Jimin Han
Clinical Endoscopy.2019; 52(1): 7. CrossRef
Causes associated with recurrent choledocholithiasis following therapeutic endoscopic retrograde cholangiopancreatography: A large sample sized retrospective study
Feng Deng, Mi Zhou, Ping-Ping Liu, Jun-Bo Hong, Guo-Hua Li, Xiao-Jiang Zhou, You-Xiang Chen
World Journal of Clinical Cases.2019; 7(9): 1028. CrossRef
A nationwide population-based study of common bile duct stone recurrence after endoscopic stone removal in Korea
Byung Kyu Park, Jeong Hun Seo, Han Ho Jeon, Jong Won Choi, Sun Young Won, Yong Suk Cho, Chun Kyon Lee, Haeyong Park, Dong Wook Kim
Journal of Gastroenterology.2018; 53(5): 670. CrossRef
Japan Gastroenterological Endoscopy Society guidelines for endoscopic papillary large balloon dilation
Takao Itoi, Shomei Ryozawa, Akio Katanuma, Yoshinobu Okabe, Hironori Kato, Jun Horaguchi, Takayoshi Tsuchiya, Takuji Gotoda, Naotaka Fujita, Kenjiro Yasuda, Yoshinori Igarashi, Kazuma Fujimoto
Digestive Endoscopy.2018; 30(3): 293. CrossRef
Recurrent common bile duct stones as a late complication of endoscopic sphincterotomy
Tatenda C. Nzenza, Yahya Al-Habbal, Glen R. Guerra, S. Manolas, Tuck Yong, Trevor McQuillan
BMC Gastroenterology.2018;[Epub] CrossRef
Comparison of late adverse events after endoscopic sphincterotomy versus endoscopic papillary large balloon dilation for common bile duct stones: A propensity score‐based cohort analysis
Akinori Maruta, Takuji Iwashita, Shinya Uemura, Kensaku Yoshida, Keisuke Iwata, Tsuyoshi Mukai, Shinpei Doi, Ichiro Yasuda, Kenji Imai, Masahito Shimizu
Digestive Endoscopy.2018; 30(4): 493. CrossRef
Comparison of the Long-Term Outcomes of Endoscopic Papillary Large Balloon Dilation Alone versus Endoscopic Sphincterotomy for Removal of Bile Duct Stones
Tao Li, Jun Wen, Like Bie, Biao Gong
Gastroenterology Research and Practice.2018; 2018: 1. CrossRef
Long-term recurrence of bile duct stones after endoscopic papillary large balloon dilation with sphincterotomy: 4-year extended follow-up of a randomized trial
Gregorios A. Paspatis, Konstantina Paraskeva, Emmanouil Vardas, Vasilios Papastergiou, Aikaterini Tavernaraki, Maria Fragaki, Angeliki Theodoropoulou, Gregorios Chlouverakis
Surgical Endoscopy.2017; 31(2): 650. CrossRef
Advances of recurrent risk factors and management of choledocholithiasis
Jian-Shan Cai, Sun Qiang, Yin Bao-Bing
Scandinavian Journal of Gastroenterology.2017; 52(1): 34. CrossRef
Endoscopic Papillary Large Balloon Dilatation Without Sphincterotomy for the Treatment of Large Common Bile Duct Stone: Long-Term Outcomes at a Single Center
Jin-Seok Park, Seok Jeong, Byung Wook Bang, Ae Ra Kang, Don Haeng Lee
Digestive Diseases and Sciences.2016; 61(10): 3045. CrossRef
The Wire-Grasping Method as a New Technique for Forceps Biopsy of Biliary Strictures: A Prospective Randomized Controlled Study of Effectiveness
Yasunobu Yamashita, Kazuki Ueda, Yuki Kawaji, Takashi Tamura, Masahiro Itonaga, Takeichi Yoshida, Hiroki Maeda, Hirohito Magari, Takao Maekita, Mikitaka Iguchi, Hideyuki Tamai, Masao Ichinose, Jun Kato
Gut and Liver.2016; 10(4): 642. CrossRef
Abdominal manifestations of histiocytic disorders in adults: imaging perspective
Abhijit Sunnapwar, Christine O Menias, Vijaynadh Ojili, Maria Policarpio Nicolas, Rashmi Katre, Kiran Gangadhar, Arpit Nagar
The British Journal of Radiology.2016; 89(1065): 20160221. CrossRef
Short-term and long-term outcomes after endoscopic sphincterotomy versus endoscopic papillary balloon dilation for bile duct stones
Yi Lu, Jia-Chuan Wu, Lei Liu, Li-Ke Bie, Biao Gong
European Journal of Gastroenterology & Hepatology.2014; 26(12): 1367. CrossRef
Long-Term Outcome of Endoscopic Papillary Large Balloon Dilatation
Chang-Il Kwon
Clinical Endoscopy.2013; 46(6): 601. CrossRef

PubReader
ePub Link

Cite

CITE: export Copy Download Format; Close

Download Citation

Download a citation file in RIS format that can be imported by all major citation management software, including EndNote, ProCite, RefWorks, and Reference Manager.

Format:

RIS — For EndNote, ProCite, RefWorks, and most other reference management software
BibTeX — For JabRef, BibDesk, and other BibTeX-specific software

Include:

Citation for the content below
Citation and abstract for the content below

Late Complications and Stone Recurrence Rates after Bile Duct Stone Removal by Endoscopic Sphincterotomy and Large Balloon Dilation are Similar to Those after Endoscopic Sphincterotomy Alone

Clin Endosc. 2013;46(6):637-642. Published online November 19, 2013

DOI: https://doi.org/10.5946/ce.2013.46.6.637

XML Download

Figure

Late Complications and Stone Recurrence Rates after Bile Duct Stone Removal by Endoscopic Sphincterotomy and Large Balloon Dilation are Similar to Those after Endoscopic Sphincterotomy Alone

Fig. 1 Measurement of the common bile duct angle. The first angulation from the ampullary orifice is measured on a cholangiogram obtained in the prone position.

Fig. 1

Late Complications and Stone Recurrence Rates after Bile Duct Stone Removal by Endoscopic Sphincterotomy and Large Balloon Dilation are Similar to Those after Endoscopic Sphincterotomy Alone

Table 1

Baseline Characteristics of the Patients

Values are presented as median (range) or number (%).

ES, endoscopic sphincterotomy; LBD, large balloon dilation; ERCP, endoscopic retrograde cholangiopancreatography.

Table 2

Complications Related to Common Bile Duct Stone Removal and Bile Duct Stone Recurrence

Values are presented as number (%).

ES, endoscopic sphincterotomy; LBD, large balloon dilation.

^a)Cause of death was delayed major bleeding; ^b)Significant overall rate, excluding minor bleeding and hyperamylasemia.

Table 3

Univariate Analysis of the Risk Factors for Bile Duct Stone Recurrence

Values are presented as median (range) or number (%).

CI, confidence interval; ERCP, endoscopic retrograde cholangiopancreatography; CBD, common bile duct; ES, endoscopic sphincterotomy; LBD, large balloon dilation.

Table 4

Multivariate Analysis of the Risk Factors for Bile Duct Stone Recurrence

ERCP, endoscopic retrograde cholangiopancreatography; CBD, common bile duct.

Table 1 Baseline Characteristics of the Patients

Values are presented as median (range) or number (%).

ES, endoscopic sphincterotomy; LBD, large balloon dilation; ERCP, endoscopic retrograde cholangiopancreatography.

Table 2 Complications Related to Common Bile Duct Stone Removal and Bile Duct Stone Recurrence

Values are presented as number (%).

ES, endoscopic sphincterotomy; LBD, large balloon dilation.

^a)Cause of death was delayed major bleeding; ^b)Significant overall rate, excluding minor bleeding and hyperamylasemia.

Table 3 Univariate Analysis of the Risk Factors for Bile Duct Stone Recurrence

Values are presented as median (range) or number (%).

CI, confidence interval; ERCP, endoscopic retrograde cholangiopancreatography; CBD, common bile duct; ES, endoscopic sphincterotomy; LBD, large balloon dilation.

Table 4 Multivariate Analysis of the Risk Factors for Bile Duct Stone Recurrence