KUMJ | VOL. 17 | NO. 1 | ISSUE 65 | JAN.-MARCH, 2019
Outcomes of Endoscopic Sphincteroplasty Using Large Balloon Dilatation for Difficult Common Bile Duct Stone Removal at Dhulikhel Hospital
Purbey BK, Gurung RB, Panday R, Shrestha A, Shah R
Abstract: Background
Endoscopic sphincteroplasty (ESPT) using a large Controlled Radial Expansion (CRE)
Wire guided balloon dilatation has gained acceptance in removing a difficult common
bile duct (CBD) stones.
Objective
To evaluate effectiveness and complications of removing large and difficult bile duct
stones with sphincterotomy combined with large balloon dilatation.
Method
A total of 132 patients, from February 2014 to June 2017, who had biliary ductal
calculus which was either greater than 15 mm or difficult to remove with standard
technique, underwent Endoscopic Retrograde Cholangiopancreaticography (ERCP)
with Endoscopic sphincteroplasty using a large Controlled radial expansion wire
guided balloon dilatation. The success rate of complete stone clearance and post
Endoscopic Retrograde Cholangiopancreaticography complications were analyzed.
Result
There were 48 (36.4 %) male and 84 (63.6%) female patients with mean age of 55.48
± 16.36 years. Stones were removed with sphincteroplasty in first attempt in 90 out
of 132 (68.2%) patients, 26 out of 37 (70.27%) patients in second session and in all
7(100%) patients in third attempt. Five (11.90%) patients were lost to follow up and
4 were advised for surgery because of failure to remove stones by sphincteroplasty.
Overall success of endoscopic sphincterotomy and large balloon dilatation in our
study was 93.18%. Complications were seen in 17 (13.6%) patients; bleeding seen in
9 (6.8%) patients and mild pancreatitis in 8 (6.1%) patients. None of the patients had
severe pancreatitis or perforation secondary to the procedure.
Conclusion
Endoscopic sphincteroplasty after sphincterotomy is an effective and safe technique
for a difficult common bile duct stone removal.
Keyword : Common bile duct stone, Controlled radial expansion, Endoscopic sphincteroplasty
