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Balloon dilation with endoscopic sphincterotomy reduced costs, need for mechanical lithotripsy

Limited endoscopic sphincterotomy with large balloon dilation reduced costs and the need for mechanical lithotripsy compared with sphincterotomy alone in patients with common bile duct stones in a recent study.

In a prospective comparative study, researchers randomly assigned 151 patients with common bile duct (CBD) stones 1.3 cm in diameter or larger to receive either endoscopic sphincterotomy (ES, n=78) or endoscopic sphincterotomy for up to half of the sphincter, followed by large balloon dilation to the size of the bile duct or 15 mm (ESBD, n=73). Removal involved dormia basket or extraction balloon, otherwise mechanical lithotripsy (ML) was performed in cases of potential impaction or larger stones.

Eighty-nine percent of ESBD participants compared with 88.5% in the ES group (P=.279) experienced complete stone clearance at index endoscopy, along with similar numbers at second endoscopic retrograde cholangiopancreatography (ERCP) (97.2% vs. 100%). No significant differences were observed between groups regarding cannulation time (mean 7.12 minutes for ES vs. 7.28 minutes for ESBD; P=.665), procedural time (27.2 minutes vs. 24.3 minutes; P=.509), mean CBD size (median 15 mm for both; P=.555), maximum stone size (13.26 mm vs. 12.47 mm; P=.994), quantity of stones (P=.211) or morbidity rates (6.8% of cases vs. 10.3%; P=.456).

ML was necessary for more ES patients (46.2% vs. 28.8%; P=.028), particularly for stones 15 mm or larger (90.9% vs. 58.1%; P=.002). Multivariate analysis indicated that maximum stone size (P<.001) and receiving ES (P=.014) were associated with the need for ML. Overall hospitalization costs were less for ESBD patients ($5,025 vs. $6,005; P=.034).

“This study showed that performance of ESBD or ES for retrieval of bile duct stones resulted in high stone clearance rates in patients with a CBD [13 mm or more] in diameter,” the researchers said. “The morbidity rates in both arms were low and comparable, and most patients who experienced morbidities had cases of mild to moderate severity. … Similar stone clearance rates were achieved with ESBD and ES. However, ESBD decreased the need for ML and was less expensive.”