Ampullary Rounding
Discussion
Ampullary widening is the most decisive part for a successful endoscopic removal of common bile duct stones. (11) ES is the most commonly used method since the first description in 1974. (18) However, ES carries substantial procedure-related risks, such as hemorrhage and perforation, and perhaps an increased incidence of ascending cholangitis and de novo formation of bile-duct stones, especially in younger patients.(19) As an alternative to ES, endoscopic papillary balloon dilation was introduced in 1982 by Staritz et al. (4) EPBD has been reported to be safe and effective for the management of CBD stones and advantageously preserves the sphincter of Oddi function, and reduce complications, such as hemorrhage and perforation, compared …show more content…
This was consistent with many recent studies.(11,14,27) In contrast, it was reported that EPLBD may cause very serious bleeding (34) and perforation. (35) In our study, the risk of bleeding associated with EPLBD was negligible. Only minor bleeding developed in 1.6% of patients in the EPLBD group and was controlled easily with diluted epinephrine solution injection or spray or balloon compression. EPLBD might have advantages in patients with coagulopathy over ES. Also retroperitoneal perforation was negligible in this study as no patients developed perforation in both groups. The size of balloon is the major determinant for the success of EPLBD. As the ampullary enlargement by balloon dilation becomes wider, stone removal can be facilitated. However, oversized balloons increase the risk of perforation or vessel injury.(14) In the present study, we used balloons between 12 and 15 mm in diameter, not exceeding the size of the CBD stone and the diameter of the distal part of the CBD. This large ballooning was safely performed because the CBD was already dilated over the size of the balloon. It is very important to avoid excessive inflation, especially in case of bile duct strictures, to prevent the risk of perforation or bleeding. The incidence of cholangitis in EPLBD group was slightly higher but not statistically significant compared to ES group (3.3% vs. 1.9%; p=0.69). This may be explained by the associated risk of ampullary edema which may be increased by
Ampullary widening is the most decisive part for a successful endoscopic removal of common bile duct stones. (11) ES is the most commonly used method since the first description in 1974. (18) However, ES carries substantial procedure-related risks, such as hemorrhage and perforation, and perhaps an increased incidence of ascending cholangitis and de novo formation of bile-duct stones, especially in younger patients.(19) As an alternative to ES, endoscopic papillary balloon dilation was introduced in 1982 by Staritz et al. (4) EPBD has been reported to be safe and effective for the management of CBD stones and advantageously preserves the sphincter of Oddi function, and reduce complications, such as hemorrhage and perforation, compared …show more content…
This was consistent with many recent studies.(11,14,27) In contrast, it was reported that EPLBD may cause very serious bleeding (34) and perforation. (35) In our study, the risk of bleeding associated with EPLBD was negligible. Only minor bleeding developed in 1.6% of patients in the EPLBD group and was controlled easily with diluted epinephrine solution injection or spray or balloon compression. EPLBD might have advantages in patients with coagulopathy over ES. Also retroperitoneal perforation was negligible in this study as no patients developed perforation in both groups. The size of balloon is the major determinant for the success of EPLBD. As the ampullary enlargement by balloon dilation becomes wider, stone removal can be facilitated. However, oversized balloons increase the risk of perforation or vessel injury.(14) In the present study, we used balloons between 12 and 15 mm in diameter, not exceeding the size of the CBD stone and the diameter of the distal part of the CBD. This large ballooning was safely performed because the CBD was already dilated over the size of the balloon. It is very important to avoid excessive inflation, especially in case of bile duct strictures, to prevent the risk of perforation or bleeding. The incidence of cholangitis in EPLBD group was slightly higher but not statistically significant compared to ES group (3.3% vs. 1.9%; p=0.69). This may be explained by the associated risk of ampullary edema which may be increased by