Large balloon dilatation versus endoscopic complete sphincterotomy in patients with large common bile duct stone(s) and periampullary diverticulum
Abstract Background Endoscopic papillary large balloon dilatation (EPLBD) is an effective technique in treating large common bile duct (CBD) stones. However, the efficacy and safety of EPLBD in the setting of periampullary diverticula (PAD) are prospectively lacking. This study aimed to compare the...
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2025-08-01
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| Series: | Egyptian Liver Journal |
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| Online Access: | https://doi.org/10.1186/s43066-025-00450-y |
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| author | Ibrahim Mohamed Ibrahim Tarek Ibrahim Zaher Soha E. Khorshed Mahmoud Mohamed Ibrahim Tarek Mostafa Ibrahim Mohammed Ahmed A. Abdelmoaty Mohamed H. Emara Mohammed A. Hasuna |
| author_facet | Ibrahim Mohamed Ibrahim Tarek Ibrahim Zaher Soha E. Khorshed Mahmoud Mohamed Ibrahim Tarek Mostafa Ibrahim Mohammed Ahmed A. Abdelmoaty Mohamed H. Emara Mohammed A. Hasuna |
| author_sort | Ibrahim Mohamed Ibrahim |
| collection | DOAJ |
| description | Abstract Background Endoscopic papillary large balloon dilatation (EPLBD) is an effective technique in treating large common bile duct (CBD) stones. However, the efficacy and safety of EPLBD in the setting of periampullary diverticula (PAD) are prospectively lacking. This study aimed to compare the effectiveness and short-term safety of EPLBD after limited sphincterotomy with those of endoscopic sphincterotomy (EST) for extracting large CBD stones in the setting of PAD prospectively. Methods Forty-eight patients with large CBD stone(s) > 1 cm were recruited. All patients had a PAD. Before the procedure, patients were evaluated by history taking, clinical examination, full investigations including proper imaging studies. During the procedure, patients were randomized to either group I: patients treated with EPLBD after limited sphincterotomy, and group II: patients treated with EST. CBD clearance was defined as a single procedure (EPLBD vs EST), single session (no repeat ERCP), and non-assisted (no lithotripsy used) stone extraction. After the procedure, patients were hospitalized with clinical, laboratory, and imaging assessment. Results The overall stone extraction rate in the current study was only 77.3% (n = 34). The efficacy of stone extraction was significantly higher in the EPLBD (n = 21,87.5%) group compared to the EST (n = 13, 54.17%) group (p = 0.011). The procedure-related adverse events were lower in the EPLBD group compared to the EST group. Pancreatitis was significantly higher in the EST (n = 6, 25%) group than in the EPLBD (n = 1, 4.1%) group (p = 0.04). There was no significant difference between the two groups regarding postoperative bleeding and cholangitis. There were no perforations or case fatalities in either group. Conclusion Compared to EST, EPLBD is a more effective and safer method for extraction of large CBD stone(s) in the setting of PAD. |
| format | Article |
| id | doaj-art-da3960732d1641c49c7a474cc3bde200 |
| institution | Kabale University |
| issn | 2090-6226 |
| language | English |
| publishDate | 2025-08-01 |
| publisher | SpringerOpen |
| record_format | Article |
| series | Egyptian Liver Journal |
| spelling | doaj-art-da3960732d1641c49c7a474cc3bde2002025-08-20T04:01:43ZengSpringerOpenEgyptian Liver Journal2090-62262025-08-0115111110.1186/s43066-025-00450-yLarge balloon dilatation versus endoscopic complete sphincterotomy in patients with large common bile duct stone(s) and periampullary diverticulumIbrahim Mohamed Ibrahim0Tarek Ibrahim Zaher1Soha E. Khorshed2Mahmoud Mohamed Ibrahim3Tarek Mostafa Ibrahim Mohammed4Ahmed A. Abdelmoaty5Mohamed H. Emara6Mohammed A. Hasuna7Hepatology, Gastroenterology, and Infectious Diseases Department, Faculty of Medicine, Zagazig UniversityHepatology, Gastroenterology, and Infectious Diseases Department, Faculty of Medicine, Zagazig UniversityHepatology, Gastroenterology, and Infectious Diseases Department, Faculty of Medicine, Zagazig UniversityTropical Medicine Department, Faculty of Medicine, Suez UniversityTropical Medicine Department, Faculty of Medicine, Suez UniversityHepatology, Gastroenterology, and Infectious Diseases Department, Faculty of Medicine, Zagazig UniversityHepatology, Gastroenterology, and Infectious Diseases Department, Faculty of Medicine, Kafrelsheikh UniversityHepatology, Gastroenterology, and Infectious Diseases Department, Faculty of Medicine, Zagazig UniversityAbstract Background Endoscopic papillary large balloon dilatation (EPLBD) is an effective technique in treating large common bile duct (CBD) stones. However, the efficacy and safety of EPLBD in the setting of periampullary diverticula (PAD) are prospectively lacking. This study aimed to compare the effectiveness and short-term safety of EPLBD after limited sphincterotomy with those of endoscopic sphincterotomy (EST) for extracting large CBD stones in the setting of PAD prospectively. Methods Forty-eight patients with large CBD stone(s) > 1 cm were recruited. All patients had a PAD. Before the procedure, patients were evaluated by history taking, clinical examination, full investigations including proper imaging studies. During the procedure, patients were randomized to either group I: patients treated with EPLBD after limited sphincterotomy, and group II: patients treated with EST. CBD clearance was defined as a single procedure (EPLBD vs EST), single session (no repeat ERCP), and non-assisted (no lithotripsy used) stone extraction. After the procedure, patients were hospitalized with clinical, laboratory, and imaging assessment. Results The overall stone extraction rate in the current study was only 77.3% (n = 34). The efficacy of stone extraction was significantly higher in the EPLBD (n = 21,87.5%) group compared to the EST (n = 13, 54.17%) group (p = 0.011). The procedure-related adverse events were lower in the EPLBD group compared to the EST group. Pancreatitis was significantly higher in the EST (n = 6, 25%) group than in the EPLBD (n = 1, 4.1%) group (p = 0.04). There was no significant difference between the two groups regarding postoperative bleeding and cholangitis. There were no perforations or case fatalities in either group. Conclusion Compared to EST, EPLBD is a more effective and safer method for extraction of large CBD stone(s) in the setting of PAD.https://doi.org/10.1186/s43066-025-00450-yEndoscopic papillary large balloon dilatationEndoscopic sphincterotomyLarge common bile duct stonesPeriampullary diverticulum |
| spellingShingle | Ibrahim Mohamed Ibrahim Tarek Ibrahim Zaher Soha E. Khorshed Mahmoud Mohamed Ibrahim Tarek Mostafa Ibrahim Mohammed Ahmed A. Abdelmoaty Mohamed H. Emara Mohammed A. Hasuna Large balloon dilatation versus endoscopic complete sphincterotomy in patients with large common bile duct stone(s) and periampullary diverticulum Egyptian Liver Journal Endoscopic papillary large balloon dilatation Endoscopic sphincterotomy Large common bile duct stones Periampullary diverticulum |
| title | Large balloon dilatation versus endoscopic complete sphincterotomy in patients with large common bile duct stone(s) and periampullary diverticulum |
| title_full | Large balloon dilatation versus endoscopic complete sphincterotomy in patients with large common bile duct stone(s) and periampullary diverticulum |
| title_fullStr | Large balloon dilatation versus endoscopic complete sphincterotomy in patients with large common bile duct stone(s) and periampullary diverticulum |
| title_full_unstemmed | Large balloon dilatation versus endoscopic complete sphincterotomy in patients with large common bile duct stone(s) and periampullary diverticulum |
| title_short | Large balloon dilatation versus endoscopic complete sphincterotomy in patients with large common bile duct stone(s) and periampullary diverticulum |
| title_sort | large balloon dilatation versus endoscopic complete sphincterotomy in patients with large common bile duct stone s and periampullary diverticulum |
| topic | Endoscopic papillary large balloon dilatation Endoscopic sphincterotomy Large common bile duct stones Periampullary diverticulum |
| url | https://doi.org/10.1186/s43066-025-00450-y |
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