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Limited endoscopic sphincterotomy plus large balloon dilation for choledocholithiasis with periampullary diverticula
Hyung Wook Kim, Dae Hwan Kang, Cheol Woong Choi, Jong Hwan Park, Jin Ho Lee, Min Dae Kim, Il Doo Kim, Ki Tae Yoon, Mong Cho, Ung Bae Jeon, Suk Kim, Chang Won Kim, Jun Woo Lee
Hyung Wook Kim, Dae Hwan Kang, Cheol Woong Choi, Jong Hwan Park, Jin Ho Lee, Min Dae Kim, Il Doo Kim, Ki Tae Yoon, Mong Cho, Department of Internal Medicine, Pusan National University School of Medicine and Medical Research Institute, Pusan National University Yangsan Hospital, Yangsan-si, Gyeongsangnam-do 626-770, South Korea
Ung Bae Jeon, Jun Woo Lee, Department of Radiology, Pusan National University School of Medicine and Medical Research Institute, Pusan National University Yangsan Hospital, Yangsan-si, Gyeongsangnam-do 626-770, South Korea
Suk Kim, Chang Won Kim, Department of Radiology, Pusan National University School of Medicine and Medical Research Institute, Pusan National University Hospital, 1-10 Ami-done, Seo-Gu, Busan 602-739, South Korea
Author contributions: Kim HW and Kang DH contributed equally to this work; Kim HW, Kang DH and Choi CW designed the research; Kim HW, Kang DH, Choi CW, Park JH, Lee JH, Kim MD, Kim ID, Yoon KT, Cho M, Jeon UB, Kim S, Kim CW and Lee JW performed the research; Kim HW and Choi CW analyzed the data; Kim HW and Kang DH wrote the paper.
Supported by A Grant of the Korea Healthcare technology R&D Project, Ministry for Health, Welfare and Family Affairs, Republic of Korea (A091047)
Correspondence to: Dae Hwan Kang, MD, PhD, Department of Internal Medicine, Pusan National University School of Medicine and Medical Research Institute, Pusan National University Yangsan Hospital, Beomeo-ri, Mulgeum-eup,Yangsan-si, Gyeongsangnam-do 626-770, South Korea. sulsulpul@yahoo.co.kr
Telephone: +82-55-3601534 Fax: +82-55-3601536
Received: February 8, 2010
Revised: May 31, 2010
Accepted: June 7, 2010
Published online: September 14, 2010
AIM: To investigate the effectiveness and safety of limited endoscopic sphincterotomy (EST) plus large balloon dilation (LBD) for removing choledocholithiasis in patients with periampullary diverticula (PAD).
METHODS: A total of 139 patients with common bile duct (CBD) stones were treated with LBD (10-20 mm balloon diameter) after limited EST. Of this total, 73 patients had PAD and 66 patients did not have PAD (controls). The results of stone removal and complications were retrospectively evaluated.
RESULTS: There were no significant differences between the PAD and the control groups in overall successful stone removal (94.5% vs 93.9%), stone removal in first session (69.9% vs 81.8%), mechanical lithotripsy (12.3% vs 13.6%), and complications (11.0% vs 7.6%). Clinical outcomes were also similar between the types of PAD, but the rate of stone removal in first session and the number of sessions were significantly lower and more frequent, respectively, in type B PAD (papilla located near the diverticulum) than controls [23/38 (60.5%) vs 54/66 (81.8%), P = 0.021; and 1 (1-2) vs 1 (1-3), P = 0.037, respectively] and the frequency of pancreatitis was significantly higher in type A PAD (papilla located inside or in the margin of the diverticulum) than in controls (16.1% vs 3.0%, P = 0.047).
CONCLUSION: Limited EST plus LBD was an effective and safe procedure for removing choledocholithiasis in patients with PAD. However, some types of PAD should be managed with caution.
