The Curative Effect And Prognosis Of Endoscopic Papillary Large Balloon Dilatation In The Treatment Of Choledocholithiasis

Objective:The choledocholithiasis were treated by simple endoscopic papillary large balloon dilation(EPLBD)or small endoscopic sphincterotomy plus large balloon dilatation(ESLBD),and the lithotomy effect and complications were compared and analyzed,so as to evaluate the efficacy and prognosis of EPLBD.Methods:A total of 153 eligible patients with choledocholithiasis(>1.0cm in diameter)admitted and treated in shanxi people’s hospital from August 2016 to November 2017 were randomly divided into two groups according to the random number table method:the endoscopic papillary large balloon dilatation group(EPLBD group,n=83 cases)and the EST plus endoscopic papillary large balloon dilatation group(ESLBD group,n=70 cases).The application rate of intraoperative mechanical lithotripsy,the stone extraction rate,the incidence of early postoperative complications(These include postoperative hyperamylase,acute pancreatitis,hemorrhage,perforation,and infection)and long-term complications were compared.Results:1.Comparison of baseline data: there were no statistically significant differences between the two groups in gender,age,with or without diverticulum,maximum stone diameter,number of stones,and common bile duct diameter.2.Comparison of lithotomy results and early postoperative complications:There was no statistically significant difference between the two groups in total and one-time stone removal rate(95.2% to 97.1%,92.8% to 90%,all P>0.05).The lithotripsy rate of EPLBD group was lower than that of ESLBD group(25.3% vs 35.7%,P>0.05),but the difference was not statistically significant.There was no statistically significant difference in the incidence of recent complications between the two groups: hyperamylasemia 32.5% vs 22.9%,pancreatitis 8.4% vs 8.6%,hemorrhage 0 vs 2.9%,all P>0.05.No postoperative perforation was found in either group.3.Comparison of postoperative long-term complications: The cumulative recurrent rate of choledocholithiasis in the two groups was 2.4% to 15.7%,P<0.05,and the difference was statistically significant.Conclusions: 1.In the treatment of large choledocholithiasis by EPLBD,the extraction rate of stone,the application rate of intraoperative mechanical lithotripsy,and the incidence of early postoperative complications were all similar to that of ESLBD,while the long-term cumulative recurrence rate of stone was lower than that of ESLBD.2.Simple EPLBD(balloon dilation diameter of 10-15mm)is also a feasible surgical method for choledocholithiasis with large diameter(>10mm).