IDDF2018-ABS-0051 Long-term outcomes of limited endoscopic sphincterotomy plus large-balloon dilation versus endoscopic papillary large-balloon dilation alone for removal of bile duct stones

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Abstract

Background

Limited endoscopic sphincterotomy with large balloon dilation (ES-LBD) and endoscopic papillary large-balloon dilation (EPLBD) alone have been proven safe and effective for removal of common bile duct (CBD) stones. However, few reports exist regarding the long-term outcomes of these techniques. The aim of this study was to assess long-term outcomes of ES-LBD compared with EPLBD alone for retrieval of CBD stones.

Methods

Patients with EPLBD alone or ES-LBD referred for CBD stones removal between June 2008 and August 2015 in our centre were retrospectively reviewed. The main outcomes of complete stone clearance, ERCP-related adverse events, late biliary complications during long-term follow-up were analysed.

Results

Basic patient characteristics were not significantly different between the groups that underwent EPLBD alone (n=164) and ES-LBD (n=52). EPLBD alone compared with ES-LBD resulted in similar outcomes in terms of overall successful stone removal (99.4% vs 100%, p=0.76) and ERCP-related adverse events (7.9% vs 5.8%, p=0.77). The mean duration of the follow-up was 70.5 months and 65.1 months who underwent EPLBD alone and ES-LBD, respectively (p=0.17). A significantly higher incidence of late biliary complications was observed in the ES-LBD group than EPLBD alone group (12 [23.1%] vs 18 [11.0%]; p=0.04). Multivariate analysis showed that endoscopic sphincterotomy (EST) (OR, 2.407; 95% CI, 1.054–5.501; p=0.037) and mechanical lithotripsy (ML) (OR, 2.981; 95% CI, 1.272–6.987; p=0.012) were independent risk factors for late biliary complications.

Conclusions

During long-term follow-up, patients who underwent ES-LBD had significantly more late biliary complications than those after EP-LBD alone. EST and ML, special attention should be paid to the possible occurrence of late biliary complications.

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