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Large-balloon dilation alone safely, effectively treated large bile duct stones

Patients with large bile duct stones treated with endoscopic large-balloon dilation alone had similar outcomes to those treated with endoscopic sphincterotomy and dilation in a recent study.

Researchers evaluated the outcomes and incidence of complications in 131 patients with common bile duct (CBD) stones of 12 mm or larger who underwent either large-balloon dilation (LBD; n=62), or LBD with endoscopic sphincterotomy (EST; n=69).

Stones were successfully removed in nearly all cases for both groups (96.8%, LBD group; 95.7%, EST/LBD group; P=.738), including patients who ultimately underwent mechanical lithotripsy (ML). The majority of patients did not require ML (80.6%, LBD; 73.9%, EST/LBD recipients; P=.36). Complete duct clearance despite ML did not occur in five cases, including two LBD patients and three EST/LBD patients because of stone impaction or incomplete capture.

Patients who experienced complete stone removal without ML had significantly smaller stones than those who did not in both groups (14.6 ± 2.1 mm vs. 20.2 ± 3.5 mm, LBD; 15.5 ± 2.9 mm vs. 19.4 ± 5.9 mm, EST/LBD). The balloon/stone diameter ratio also was higher in these cases (1.01 ± 0.1 vs. 0.82 ± 0.08, LBD; 1.15 ± 0.19 vs. 0.90 ± 0.18, EST/LBD) (P<.001 for all comparisons).

Complications occurred at similar rates between groups, and included pancreatitis (6.5% of LBD recipients vs. 4.3% in the EST/LBD group; P=.593), perforation (0% vs. 1.4%; P=.341) and basket and stone impaction (0% vs. 1.4%; P=.341). All complications were resolved, and investigators noted that no significant hemorrhages occurred.

“To our knowledge, this is the first study to compare the efficacy and safety of LBD alone with [EST/LBD] for the treatment of large bile duct stones,” the researchers wrote. “LBD alone may be a simple, safe and effective alternative to [EST/LBD] in relatively aged patients with large CBD stones, and it can simplify the procedure compared with [EST/LBD].

“[However,] the efficacy and safety of LBD alone in relatively young patients with large CBD stones remains uncertain.”