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首页> 外文期刊>Surgical Endoscopy >Can a small endoscopic sphincterotomy plus a large-balloon dilation reduce the use of mechanical lithotripsy in patients with large bile duct stones?
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Can a small endoscopic sphincterotomy plus a large-balloon dilation reduce the use of mechanical lithotripsy in patients with large bile duct stones?

机译：在大胆管结石患者中，小的内窥镜括约肌切开术加大气球扩张术可以减少机械性碎石术的使用吗？

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BACKGROUND: Endoscopic retrograde cholangiopancreatography (ERCP) with endoscopic sphincterotomy (EST) is technically difficult in the patients with large extrahepaic bile duct stones. Small endoscopic sphincterotomy combined with large-balloon dilation (ESLBD) currently seems to be a promising alternative for patients with difficult bile duct stones that cannot be extracted by EST. This study compared the therapeutic benefits and complication rates of ESLBD with those of EST alone. METHODS: This study investigated 149 patients treated for stones (>/=10 mm) or multiple stones in the extrahepatic bile duct. The ESLBD group (n = 72) was compared with the conventional EST group (n = 77). Mechanical lithotripsy was performed when the stone could not be removed using a Dormia basket. RESULTS: The two groups did not differ significantly in terms of mean bile duct diameter, common bile duct angulation, and presence of periampullary diverticulum. The ESLBD group compared with the EST-alone group had similar outcomes in terms of overall successful stone removal but showed significant differences in complete stone removal during the first session (87.5 vs. 74.0%; P = 0.036) and the use of mechanical lithotripsy for large bile duct stones (>/=15 mm) (17.9 vs. 45.8%; P = 0.026). For the patients with a periampullary diverticulum, ESLBD and EST showed similar results only for efficacy and complications. CONCLUSIONS: The ESLBD technique may be a safe, effective alternative to conventional EST for endoscopic removal of large common bile duct stones, and it can reduce the use of mechanical lithotripsy compared with EST alone.
机译：背景：内镜下括约肌切开术（EST）的内镜逆行胰胆管造影术（ERCP）在大肝外胆管结石患者中在技术上是困难的。小内镜括约肌切开术结合大气球扩张术（ESLBD）目前似乎是难以通过EST摘除的困难胆管结石患者的有前途的替代方法。这项研究比较了ESLBD与单纯EST的治疗益处和并发症发生率。方法：本研究调查了149例接受治疗的肝外胆管结石（> / = 10 mm）或多发结石的患者。将ESLBD组（n = 72）与常规EST组（n = 77）进行比较。当无法使用Dormia提篮除去石头时，进行机械碎石术。结果：两组在平均胆管直径，胆总管角度和壶腹周围憩室的存在方面无显着差异。 ESLBD组与单纯EST组相比，结石清除总体成功率相似，但在第一次治疗中完全结石清除率存在显着差异（87.5 vs. 74.0％; P = 0.036）以及使用机械碎石术治疗大胆管结石（> / = 15毫米）（17.9比45.8％; P = 0.026）。对于壶腹周围憩室的患者，ESLBD和EST仅在疗效和并发症方面显示出相似的结果。结论：ESLBD技术可能是常规EST的内窥镜下胆总管结石的安全，有效替代，并且与单独使用EST相比，它可以减少机械性碎石术的使用。

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