Clinical Study On The Efficacy Of Small Duodenal Papillary Sphincter Incision Combined With Immediate Balloon Dilation On Common Bile Duct Stones

Objective:In order to compare the effects of endoscopic sphincterotomy(EST)in combination with endoscopypic papillary balloon dilation(EPBD)with different durations,such as immediately(0 s),30 s,and 1 min,respectively,in patients with common bile duct stones.Methods:A total of 117 patients treated with endoscopic retrograde cholangiopancreatography(ERCP)at The First Affiliated Hospital of Gannan Medical Univercity between December 30,2018 and December 30,2022 were included.In this study,two types of grouping were used: 1.the patients were divided into 3 groups according to the different durations of balloon dilation,divided into 0 s group(n = 39),30 s group(n = 40),and 1 min group(n = 38);the patients in the three groups were compared with(1)general conditions: age,gender,comorbidities,hepatobiliary stones,anesthesia classification,(2)stone,diverticulum characteristics and intraoperative conditions;(3)preoperative and postoperative laboratory indices(4)stone extraction results and hospitalization;(5)early postoperative complications;2.the patients were divided into 2 groups according to age,with age ≥ 65 years as the elderly group(n =67)and age < 65 years as the non-elderly group(n = 50);the success rate of one-time stone extraction and postoperative complications were compared between the two groups.Results:By analyzing the incidence of post-ERCP complications in the 0 s,30 s,and 1 min groups,it was concluded that the incidence of post-ERCP pancreatitis(PEP)in the 0 s group was significantly lower than that in the 30 s and 1 min groups,and the difference was statistically significant(P < 0.05);the incidence of the remaining complications:bleeding,perforation,infection,etc.were similar in the 0 s,30 s,and 1 min groups,and the difference was not statistically significant(P > 0.05).The success rate of one-time stone extraction in the 0 s,30 s,and 1 min groups were similar,and the differences were not statistically significant(P > 0.05).The success rate of the elderly group was97.0 %,which was slightly lower than that of the non-elderly group(100 %),and the difference between the success rate of the elderly group and the non-elderly group was not statistically significant(P > 0.05).The postoperative complication rate in the elderly group was 8.9% compared to 8.0% in the non-elderly group with no statistically significant difference(P > 0.05).Conclusion:The following conclusions were drawn from a study of balloon dilation with different durations of 0 s,30 s,and 1 min,respectively,combined with small endoscopic sphincterotomy and balloon dilation(ESBD)for the treatment of the patients with common bile duct stones.(1)The 0 s group has a similar success rate of stone extraction compared with the30 s and 1 min groups,and reduces the incidence of PEP without increasing other postoperative complications.Moreover,the 0 s group can reduce the operative time.Therefore,the duodenal papillary sphincter resection combined with immediate balloon dilation provides a new option for the clinical treatment of the patients with common bile duct stones.(2)ERCP treatment in the elderly(≥ 65 years old)is safe and effective.