Comparative Efficacy And Safety Analysis Of Endoscopic Papillary Large Balloon Dilation And Mechanical Lithotripsy In The Treatment Of Choledocholithiasis With Large Stone

BackgroundCommon bile duct stones(CBDS)are common and frequently-occurring diseases of the biliary system,accounting for 10%to 15%of cholelithiasis.Some patients will be accompanied by severe complications,including acute obstructive suppurative cholangitis and severe acute pancreatitis,which can be life-threatening in these cases.Therefore,the early intervention of stone removal is of great significance.Domestic and international guidelines recommend that endoscopic papillary incision(EST)stone removal plus basket or balloon extraction under Endoscopic retrograde cholangiopancreatography(ERCP)is the preferred method for the treatment of common bile duct stones,while for diameter Stones≥12mm are still one of the difficulties in the operation of ERCP.Mechanical lithotripsy(ML)has been the first choice for large bile duct stones in the past few decades and has achieved good results.ML has been through lithotripsy nets.The basket sets the stones,and the method of mechanical stone crushing is used to reduce the stones,which is beneficial to the removal of the stones.Endoscopic sphincterotomy plus large-balloon dilation(EPLBD)was first reported in2003,and it has been widely used in the treatment of large common bile duct stones.Studies have shown that EPLBD has a higher success rate than endoscopic sphincterotomy(EST),lowers the use rate of ML,and lowers the rate of overall adverse events.In the current research,most of the EPLBD failed to remove the stone,and then the ML is used for the stone removal after the crushing,and there are few direct comparison studies between the two.ObjectiveA retrospective study of comparative efficacy and safety analysis of endoscopic papillary large balloon dilation and mechanical lithotripsy in the treatment of choledocholithiasis with large stone to better guide the choice of clinical operation methods.MethodCollected 153 patients diagnosed as common bile duct stones(diameter≥12mm)after ERCP stone removal in our hospital from January 2017 to January 2020.All patients underwent small or medium endoscopic sphincterotomy incision,including 60cases treated with EPLBD,and 93 cases treated with ML according to the different methods of stone removal.Compared the rate of one-session stone removal,the impact on liver function,hospital stay time,postoperative complications(hyperamylaseemia,pancreatitis,hemorrhage,postoperative infection)and the residual rate of stones and the recurrence rate after surgery between the two groups.ResultA total of 153 patients were enrolled in this study,including 60 in the EPLBD group and 93 in the ML group.The clinical symptoms such as abdominal pain,bloating,nausea,vomiting,and jaundice were effectively relieved in both groups.There were no significant differences in baseline data such as gender,age,preoperative liver function,white blood cells,neutrophil percentage,common bile duct diameter,and maximum stone diameter.There were 54 cases(90%)in the EPLBD group with one-session stone removal and 72 cases(77.4%)in the ML group with one-session stone removal.There was a statistically significant difference between the two groups(Χ~2=3.972,P=0.046).The stone retrieval time of EPLBD was 14.95±7.20 min,while that of the ML group was22.28±9.15 min,the difference was statistically significant(t=-5.245,P<0.01).The liver function indexes of patients ALT、ALP、γ-GT、DBIL、TBIL in the EPLBD group after surgery were significantly improved compared with those before surgery(P values were 0.013,0.006,0.008,P<0.01、0.010).There was no significant statistics before and after AST differences in the study(t=1.733,P=0.088);ALT,AST,ALP,DBIL,TBIL in the ML group were significantly improved compared with preoperatively(P values were 0.021,0.037,0.042,P<0.01,0.023),Between the two groups,there were no significant difference between preoperative and postoperative differences(P values were 0.271、0.490、0.316、0.282、0.201、0.402).In terms of postoperative complications,8 cases(13.3%)with postoperative hyperamylasemia in the EPLBD group,5 cases(8.3%)with pancreatitis,and 8 cases with hemorrhage,including 2 cases(3.3%)with capillary hemorrhage.Intraoperative bleeding 6 cases(10%);ML group complicated postoperative hyperamylasemia in 9cases(9.7%),complicated pancreatitis in 8 cases(8.6%),and hemorrhage in 11 cases,of which 2 cases(2.2%)of capillary hemorrhage,9 cases(9.7%)of intraoperative hemorrhage,there was no statistically significant difference between the two groups in hemorrhage,pancreatitis,and hyperamylasemia(all P>0.05).The residual rate of stones in the EPLBD group was 5.6%(3/54);the residual rate of stones in the ML group was 12.5%(9/72),and there was no significant difference between the two groups(Χ~2=1.727,P=0.189).There were 3 cases(5.6%)of stones recurring in the EPLBD group and 13 cases(18.1%)of stones in the ML group.There was a statistical difference between the two groups(Χ~2=4.349,P=0.037).ConclusionBoth EPLBD and ML under ERCP can effectively alleviate clinical symptoms and improve liver function of patients.Compared with ML,EPLBD can effectively shorten the time of stone removal,increase the rate of one-session stone removal,and reduce the rate of stone recurrence.In terms of complications,there was no significant difference between the two groups in hemorrhage,pancreatitis,hyperamylasemia,and stone residual rate.