Efficacy and safety of EPLBD for choledocholithiasis in patients with surgically altered gastrointestinal anatomy

Abstract

We evaluated the efficacy and safety of endoscopic papillary large balloon dilation (EPLBD) for the treatment of difficult common bile duct (CBD) stones in patients with altered gastrointestinal anatomy. The study group comprised 16 patients (15 male, 1 female) who underwent EPLBD for CBD stones with surgically altered gastrointestinal anatomy between February 2011 and May 2013. Reconstruction was performed by Billroth II gastrectomy in five patients and Roux-en-Y gastrectomy in 11 patients. The median diameter of the maximum stone removed was 12.0 mm (range 8-26 mm) and the mean diameter of the CBD was 14.8±3.3 mm. Twelve patients had an intact papilla, but in four patients EST or EPBD had previously been performed. The median diameter of balloon used was 12.8 mm (range 10-16.5 mm) . In all the patients, EPCP was performed with single-balloon enteroscopy and EPLBD was performed without EST. CBD stones were successfully removed in all patients. Repeated sessions of ERCP were required in only three patients (19%) to completely remove the CBD stones. The average total therapeutic time was 44.2±20.7 min. Mechanical lithotripsy was required in only one case (6%) . Acute complications from EPLBD included mild bleeding in one patient (6%) . Pancreatitis and other complications were not observed. Stone recurrence was not detected in the eight patients available for follow up. In cases of altered gastrointestinal anatomy, EPLBD without EST is a safe and highly effective technique for the removal of CBD stones.