A team from Ludwigshafen, Germany, compared the efficacy and short-term complication rates of endoscopic sphincterotomy (EST) and endoscopic papillary balloon dilation (EBD) for removing uncomplicated bile duct stones.
60 patients were randomly assigned to receive either EST (n = 30) or EBD (n = 30), prior to removal of bile duct stones.
The patient groups were comparable with regard to sex and age ratios, the size of the stones (EST: mean 10 mm, EBD: mean 7 mm) and the numbers of stones (EST: mean 1.8, EBD: mean 1.6).
EBD was carried out using a balloon-tipped biliary catheter with a maximum diameter of 24 Fr, for 45-60 seconds. Bile duct stones were removed using Dormia baskets or retrieval balloons, or both.
The two methods were successful in all patients studied.
|Endoscopic sphincterotomy for stone removal will continue to be standard|
Subsequent stone removal was found to be possible in all 30 patients after EST (100%) and in 23 of the 30 who underwent EBD (77%), respectively.
After conversion to EST, complete bile duct clearance was also achieved in the remaining 7 EBD patients.
The mean duration for the whole procedure was 17 min for EST and 29 min for EBD.
Complications were observed in 5 of the 30 EST patients (3 cases of mild pancreatitis, 2 of hemorrhage) and in 9 of the 30 EBD patients (3 cases of cholangitis, 4 of mild pancreatitis, and 2 of severe pancreatitis). This showed a trend toward higher complication rates in the EBD group.
Post-intervention hyperamylasemia was observed in 6 patients (3 in each group).
Author J. C. Arnold, of the Ludwigshafen City Hospital, said on behalf of the group, "The results of this prospective randomized pilot study indicate that EST is superior to EBD, in terms of stone removal, duration of the procedure, and complication rates.
"EST will therefore continue to be the standard procedure for stone removal in the near future."
"Further studies will be needed in order to compare the longer-term results with EST and EBD," it was concluded.