Randomized trial of 1-minute versus 5-minute endoscopic balloon dilation for extraction of bile duct stones
Journal
Gastrointestinal Endoscopy
Journal Volume
72
Journal Issue
6
Pages
1154-1162
Date Issued
2010
Author(s)
Lee C.-T.
Chang C.-Y.
Leung J.W.
Chen J.-H.
Tsai M.-C.
Lin J.-T.
Abstract
Background Endoscopic papillary balloon dilation (EPBD) has a lower risk of hemorrhage than sphincterotomy and is easier to perform in altered/difficult anatomy. However, the sphincter of Oddi (SO) is only stretched but not cut after EPBD. Therefore, the biliary orifice is less opened, and failed stone extraction with EPBD alone occurs in up to 20% of patients. An uncut SO also may exacerbate pancreatic duct compression from edema after EPBD, and it increases the risk of pancreatitis. Objective To determine whether a longer duration for EPBD (5-minute vs conventional 1-minute) can further weaken the SO and reduce the rates of failed stone extraction and pancreatitis. Design Prospective, randomized trial. Setting Two tertiary-care referral centers. Patients This study involved 170 consecutive patients with common bile duct stones. Intervention EPBD for 1 minute (n = 86) or 5 minutes (n = 84). Main Outcome Measurements Failed stone extraction with EPBD alone and post-ERCP pancreatitis. Results Failed stone extraction with EPBD alone was less frequent with 5-minute EPBD (6 of 84, 7.1%) than with 1-minute EPBD (17 of 86, 19.8%), with a relative risk (RR) of 0.36 (P = .024). The risk of pancreatitis was also lower with 5-minute EPBD (4 of 84, 4.8%) than with 1-minute EPBD (13 of 86, 15.1%), with an RR of 0.32 (P = .038). Multivariable logistic regression analyses reaffirmed that 5-minute EPBD reduced the risk of failure with EPBD alone (odds ratio [OR] 0.19, P = .010) and pancreatitis (OR 0.28, P = .035). Limitations Endoscopists could not be blinded after the dilation durations were randomly assigned. Conclusion Compared with conventional 1-minute EPBD, 5-minute EPBD improves efficacy of stone extraction and reduces the risk of pancreatitis. (Clinical trial registration number: NCT00451581) ? 2010 American Society for Gastrointestinal Endoscopy.
SDGs
Other Subjects
amylase; triacylglycerol lipase; adult; aged; amylase blood level; article; balloon dilatation; cholangitis; cholecystitis; clinical trial; common bile duct stone; controlled clinical trial; controlled study; double blind procedure; endoscopic papillary balloon dilation; endoscopic retrograde cholangiopancreatography; female; human; major clinical study; male; Oddi sphincter; pancreatitis; priority journal; prospective study; randomized controlled trial; risk factor; tertiary health care; treatment duration; treatment failure; triacylglycerol lipase blood level; Adult; Aged; Balloon Dilation; Cholangiopancreatography, Endoscopic Retrograde; Double-Blind Method; Female; Gallstones; Humans; Lithotripsy; Male; Middle Aged; Pancreatitis; Prospective Studies; Retreatment; Risk; Risk Factors; Treatment Failure
Type
journal article