IS COMBINATION OF BILIARY SPHINCTEROTOMY AND BALLOON DILATATION A BETTER OPTION THAN EITHER ALONE IN ENDOSCOPIC REMOVAL OF BILE DUCT STONES? A COMPARATIVE STUDY
Mohamed E. Enaba1, Mohamed M. El-Bedewy1, Medhat Ghazy1 and Dina H. Ziada2
1Departments of Internal Medicine & 2Tropical Medicine, Faculty of Medicine, Tanta University, Egypt
Background: Removal of bile duct stones is one of the leading indications for Endoscopic Retrograde Cholangio-Pancreatography (ERCP). The management of common bile duct stones involves cannulation of the common bile duct and retrieval of the stone/s after enlarging the papillary opening, either by cutting the biliary sphincter with endoscopic sphincterotomy (EST) or by endoscopic large balloon dilatation (LBD).
Aim: In the present work we compared the therapeutic benefits and complications between endoscopic sphincterotomy (EST) alone, endoscopic large balloon sphincteroplasty (ELBS) without preceding sphincterotomy and EST plus LBD.
Patients and Methods: The present study included 60 patients with obstructive jaundice due to common bile duct stones. Patients chosen for our study were divided into three groups according to the order of the procedure. All patients were subjected to routine laboratory investigations with special stress on; complete blood count, liver function tests, serum lipase, serum amylase& serum alkaline phosphatase in addition to abdominal ultrasound & Magnetic Resonant Cholangio-Pancreatography (MRCP).
Results: (5%) complications in group (A) one patient with melena. (5 %) in group (B) one patient with acute pancreatitis. (10%) complications in group(C) one patient with acute pancreatitis & another patient with failure of complete stone extraction. No perforation occurred in any of the cases in the 3 groups (0%).Conclusion: EST plus LBD was found to be an effective alternative to EST alone. Using balloon dilatation alone is less bleeding with more risk of pancreatitis, and more use of mechanical lithotripsy, with no difference in perforation rates, However, there are a number of situations such as coagulopathy, or need for anticoagulation, that favor use of EBD. EST plus LBD technique may be more likely useful in specific groups of patients suggested by other studies tapered distal bile duct & large, square barrel-shaped or multiple stones.
Recommendations: All the three methods are safe & effective for removal of bile duct stones, but each method has its different complications.