Superiority of 10-mm-wide Balloon over 8-mm-wide Balloon in Papillary Dilation for Bile Duct Stones: A Matched Cohort Study |
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Authors: | Dai Akiyama Tsuyoshi Hamada Hiroyuki Isayama Yousuke Nakai Takeshi Tsujino Gyotane Umefune Naminatsu Takahara Dai Mohri Hirofumi Kogure Saburo Matsubara Yukiko Ito Natsuyo Yamamoto Naoki Sasahira Minoru Tada Kazuhiko Koike |
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Institution: | Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan;1.Department of Gastroenterology, Japanese Red Cross Medical Center, Tokyo, Japan |
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Abstract: | Background/Aims:Endoscopic papillary balloon dilation (EPBD) is a possible alternative to endoscopic sphincterotomy (EST) for common bile duct (CBD) stones. To date, 10- and 8-mm EPBD have not been fully compared.Patients and Methods:Patients who underwent EPBD for CBD stones at two Japanese tertiary care centers between May 1994 and January 2014 were identified. Matched pairs with 10- and 8-mm EPBD were generated. Short- and long-term outcomes were compared between the two groups.Results:A total of 869 patients were identified (61 and 808 patients for 10- and 8-mm EPBD, respectively), and 61 well-balanced pairs were generated. The rate of complete stone removal within a single session was higher in the 10-mm EPBD group than in the 8-mm EPBD group (69% vs. 44%, P < 0.001), and use of lithotripsy was less frequent in the 10-mm EPBD group (23% vs. 56%, P < 0.001). The rates of post-ERCP pancreatitis were similar between the 10- and 8-mm EPBD groups (11% vs. 8%). Cumulative biliary complication-free rates were not statistically different between the two groups: 88% 95% confidence interval (CI): 79–97%] and 94% (95% CI: 88–100%) at 1 year and 69% (95% CI: 56–85%) and 80% (95% CI: 69–93%) at 2 years in the 10- and 8-mm EPBD groups, respectively. In the 10-mm EPBD group, ascending cholangitis was not observed, and pneumobilia was found in 5% of cases during the follow-up period.Conclusions:EPBD using a 10-mm balloon for CBD stones is safe and more effective than 8-mm EPBD. The sphincter function is highly preserved after 10-mm EPBD. |
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Keywords: | Common bile duct stone endoscopic retrograde cholangiopancreatography lithotripsy pancreatitis papillary balloon dilation |
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