Comparative Study Of Endoscopic Sphincterotomy And Small Endoscopic Sphincterotomy Plus Balloon Dilation For The Treatment Of Common Bile Duct Stones

Objective: To evaluate the efficacy,safety and clinical application value of small endoscopic sphincterotomy plus balloon dilation for different diameter common bile duct stones.Method: Out of all patient cases with common bile duct stone(s)treated with undergoing endoscopic sphincterotomy(EST)or small endoscopic sphincterotomy plus balloon dilation(s EST+EPBD)from January 2012 to January 2016 in the Affliated Hospital of Inner Mongolia Medical University,151 meeting study criteria cases have been collected and retrospectively reviewed.Stone removal and the complication rate in the two groups have been statistically counted and compared.Results:(1)The rates of overall stone removal and stone removal in the first session were not significantly different between the two groups(P > 0.05);But the rate of mechanical lithotripsy use was significantly lower in the s EST +EPBD group than EST group(P < 0.05).(2)For different diameter common bile duct stones,there were no significant differences between the two groups regarding complete stone removal and stone removal in the first session;But for the stones were 11-15 mm and >15 mm in diameter,the rate of stone removal in the first session was higher in the s EST+EPBD group(P > 0.05),and the rate of mechanical lithotripsy use was significantly lower in the s EST +EPBD group(P < 0.05).(3)The rates of pancreatitis(EST 6.9% vs s EST+EPBD2.5%),hyperamylasemia(EST 4.2% vs s EST+EPBD 1.3%),cholangitis(EST 4.2% vs s EST+EPBD 0%)and hemorrhage(EST 4.2% vs s EST+EPBD 0%)were not significantly different between the two groups(P > 0.05,respectively),and perforation were not observed in any patient,but the overall rate of early complications in the s EST+EPBD group was significantly lower than in the EST group(P < 0.05);And for the stone size larger than 10 mm,the overall rate of early complications in the s EST+EPBD group also was significantly lower than in the EST group(P < 0.05).(4)The incidence of long-term complications of s EST+EPBD was significantly lower than that of EST group,such as the recurrence of cholangitis and CBD stones(P < 0.05).Conclusions:(1)s EST+EPBD is a valuable treatment technique for common bile duct stones.(2)Comparing with EST alone,s EST+EPBD has a higher rate of stone removal in the first session,and it is lower than EST in the rate of mechanical lithotripsy use and can reduce the incidence of short-term and long-term complications,especially for bile duct stones >10 mm in size.