Su1407 Safety and Effectiveness of Endoscopic Sphincterotmy Plus Large Balloon Dilation: Single Center Mid-Term Outcome

Safety and Effectiveness of Endoscopic Sphincterotmy Plus Large Balloon Dilation: Single Center Mid-Term Outcome Fumihide Itokawa*, Takao Itoi, Atsushi Sofuni, Takayoshi Tsuchiya, Nobuhito Ikeuchi, Reina Tanaka Tokyo Medical University, Tokyo, Japan Background: Endoscopic sphincterotmy plus large balloon dilation (ESLBD) would theoretically favorable for extracting large bile duct stones. Although there are many studies on the feasibility and short-term outcome, there is no midto long-term outcome after ESLBD. The aim of our study is to evaluate the mid-term outcome of ESLBD. Methods: 168 patients with large bile duct stones who underwent ESLBD from November 2006 through December 2011 were retrospectively reviewed. The patients were observed till November 2012. In the present study, inclusion criteria were used to select patients with large and/or multiple bile-duct stones: 1) bile duct stone, 13 mm or more in shortest dimensionor 2) multiple ( 3) bile-duct stones, with the smallest more than 10 mm in shortest dimension. Exclusion criteria included coagulopathy, marked thrombocytopenia, anticoagulation therapy, acute pancreatitis, septic shock. After endoscopic sphincterotomy or prior sphincterotomy, the papillary balloon catheter (maximum diameter 15 mm, 18 mm, or 20 mm) was passed over the guidewire and positioned across the main duodenal papilla. The size of balloon was matched to the diameters of the bile duct and the stones. Results: The patients mean age were 76.8 9.8years. The history of gastric operation was 140 with none (normal), 2 with Billroth 1, 11 with Billroth 2 and 15 with Rouxen Y. 70 patients (41.7%) had periampullary diverticulum. The presence of Gallstone was 65 (38.7%), the history of cholecystectomy was 42(25%), the previous sphincterotomy was 33 (19.6%). The mean follow up period were 39.85 13.7 months (range 11-69). 7 patients (4.2%) occurred stone recurrence (Mean age 72.8 7.8, surgically altered anatomy: none 6, Billroth 2 1, Gallstone 3, Periampullary diverticulum 1, History of sphincterotomy 6 (85.7%), History of stone recurrence 6 (85.7%)). There were no recurrence who had first ESLBD treatment. Conclusions: ESLBD can be safely and effectively performed. Furthermore, our mid-term outcome revealed that ESLBD is low risk of recurrence of bile duct stones. Thus, although further lon-term outcome seems to be mandatory, it will be promising treatment in patients with difficult bile duct stones.