Efficacy and Safety of Endoscopic Papillary Large Balloon Dilatation (EPLBD) for the Extraction of Common Bile Duct Stones: EPLBD for the Extraction of Common Bile Duct Stones

Sidra Rasheed; Muhammad Ahsan Farooq; Muhammad Asim Hameed; Akif Dilshad; Israr Ul Haque; Ghias Un Nabi Tayyab

doi:10.54393/pjhs.v6i5.2784

Authors

Sidra Rasheed Ameer Ud Din Medical College, Lahore General Hospital, Lahore, Pakistan
Muhammad Ahsan Farooq King Edward Medical University, Mayo Hospital, Lahore, Pakistan
Muhammad Asim Hameed Services institute of Medical Sciences, Services Hospital, Lahore, Pakistan
Akif Dilshad Ameer Ud Din Medical College, Lahore General Hospital, Lahore, Pakistan
Israr Ul Haque King Edward Medical University, Mayo Hospital, Lahore, Pakistan
Ghias Un Nabi Tayyab Ameer Ud Din Medical College, Lahore General Hospital, Lahore, Pakistan

DOI:

https://doi.org/10.54393/pjhs.v6i5.2784

Keywords:

Sphincterotomy, Endoscopic Papillary Large Balloon Dilatation, Difficult Bile Duct Stones, Mechanical Lithotripsy

Abstract

Endoscopic Papillary Large Balloon Dilatation (EPLBD) is an endoscopic technique which combines limited endoscopic sphincterotomy followed by balloon dilation, leading to increased stone extraction rate with minimum complications of Endoscopic Biliary Sphincterotomy (EBS), Endoscopic Balloon Dilatation (EBD) alone and more advanced Mechanical (ML) and Laser Lithotripsy. Objectives: To evaluate the efficacy and safety of EPLBD procedure by using balloon size of 12-20 mm to remove difficult CBDS of ≥15mm. Methods: A total of 105 patients fulfilling the inclusion criteria underwent ERCP with EBS at the Endoscopy Department, Lahore General Hospital, Lahore. EPLBD was done with gradual balloon expansion from 12 to 20 mm till the disappearance of the waist under fluoroscopy. Technical success was recorded as complete stone removal. Patients were observed for 24 hours post-procedure for any complications. The data were processed on SPSS version 23.0. Descriptive statistics were employed to calculate means and standard deviation for age, size and number of stones, bilirubin level, CBD size and size of EPLBD in mm and time of balloon inflation in seconds. Success rate and complications were expressed in percentages. Results: Data of total 105 patients were collected. The mean age of patients was calculated to be 52.28 years, with female gender predominance (F=62, M=43). The average size of the balloon used was 15.32 ± 1.93mm. The overall success rate for stone extraction, irrespective of the number of sessions or the use of ML, was 95 (90.5%). Post EPLBD complications percentage was 7 (6.7%) (3.8% Bleed, 1.9% pancreatitis, 1% perforation). Conclusion: EPLBD is a safe and effective method for the removal of large bile duct stones of >15 mm.

References

Younis M, Pencovich N, El-On R, Lubezky N, Goykhman Y, Phillips A et al. Surgical Treatment for Choledocholithiasis Following Repeated Failed Endoscopic Retrograde Cholangiopancreatography. Journal of Gastrointestinal Surgery. 2022 Jun; 26(6): 1233-40. doi: 10.1007/s11605-022-05309-w. DOI: https://doi.org/10.1007/s11605-022-05309-w

Tringali A, Costa D, Fugazza A, Colombo M, Khalaf K, Repici A et al. Endoscopic Management of Difficult Common Bile Duct Stones: Where Are We Now? A Comprehensive Review. World Journal of Gastroenterology. 2021 Nov; 27(44): 7597. doi: 10.3748/wjg.v27.i44.7597. DOI: https://doi.org/10.3748/wjg.v27.i44.7597

De Oliveira LB, Funari MP, Kum AS, de Moraes Bestetti A, Brunaldi VO, Franzini TA et al. Pure cut vs. Endocut in Endoscopic Biliary Sphincterotomy: Systematic Review and Meta-Analysis of Randomized Clinical Trials. Endoscopy International Open. 2024 Jul; 12(07): E830-41. doi: 10.1055/a-2325-3821. DOI: https://doi.org/10.1055/a-2325-3821

Manti M, Shah J, Papaefthymiou A, Facciorusso A, Ramai D, Tziatzios G, Papadopoulos V et al. Endoscopic Management of Difficult Biliary Stones: An Evergreen Issue. Medicina. 2024 Feb; 60(2): 340. doi: 10.3390/medicina60020340. DOI: https://doi.org/10.3390/medicina60020340

Staritz M, Ewe K, Zum Büschenfelde KH. Endoscopic Papillary Dilation (EPD) for the Treatment of Common Bile Duct Stones and Papillary Stenosis. Endoscopy. 1983 May; 15(S 1): 197-8. doi: 10.1055/s-2007-1021507. DOI: https://doi.org/10.1055/s-2007-1021507

Hu J, Mu N, He Y. Comparing the Efficacy of Endoscopic Balloon Dilation Alone and Combined with Endoscopic Sphincterotomy for Common Bile Duct Stone: A Systematic Review and Meta-Analysis. Annals of Palliative Medicine. 2022 Jan; 11(1): 16372-172. doi: 10.21037/apm-21-3557. DOI: https://doi.org/10.21037/apm-21-3557

Ersoz G, Tekesin O, Ozutemiz AO, Gunsar F. Biliary Sphincterotomy Plus Dilation with A Large Balloon for Bile Duct Stones That Are Difficult to Extract. Gastrointestinal Endoscopy. 2003 Feb; 57(2): 156-9. doi: 10.1067/mge.2003.52. DOI: https://doi.org/10.1067/mge.2003.52

Lesmana CR, Paramitha MS, Lesmana LA. Innovation of Endoscopic Management in Difficult Common Bile Duct Stone in the Era of Laparoscopic Surgery. World Journal of Gastrointestinal Endoscopy. 2021 Jul; 13(7): 198. doi: 10.4253/wjge.v13.i7.198. DOI: https://doi.org/10.4253/wjge.v13.i7.198

Grande G, Cocca S, Bertani H, Caruso A, Mangiafico S, Russo S et al. Dilation Assisted Stone Extraction for Complex Biliary Lithiasis: Technical Aspects and Practical Principles. World Journal of Gastrointestinal Endoscopy. 2021 Feb; 13(2): 33. doi: 10.4253/wjge.v13.i2.33. DOI: https://doi.org/10.4253/wjge.v13.i2.33

Wang J, Cao L, Cong Y, Huang Y, Wang L, Wang W et al. Comparative Efficacy and Safety of 3 Endoscopic Techniques for the Treatment of Large Common Bile Duct Stones (≥15 Mm): Long-Term Follow-Up. Gastrointestinal Endoscopy. 2024 Dec. doi: 10.1016/j.gie.2024.12.025. DOI: https://doi.org/10.1016/j.gie.2024.12.025

Yamauchi H, Iwai T, Okuwaki K, Miyata E, Kawaguchi Y, Matsumoto T et al. Risk Factors for Perforation During Endoscopic Papillary Large Balloon Dilation and Bile Duct Stone Removal. Digestive Diseases and Sciences. 2022 May; 67(5): 1890-900. doi: 10.1007/s10620-021-06974-8. DOI: https://doi.org/10.1007/s10620-021-06974-8

Jin PP, Cheng JF, Liu D, Mei M, Xu ZQ, Sun LM. Endoscopic Papillary Large Balloon Dilation Vs Endoscopic Sphincterotomy for Retrieval of Common Bile Duct Stones: A Meta-Analysis. World Journal of Gastroenterology. 2014 May; 20(18): 5548. doi: 10.3748/wjg.v20.i18.5548. DOI: https://doi.org/10.3748/wjg.v20.i18.5548

Shim CS. Balloon Dilation of the Native and Post-Sphincterotomy Papilla. In Endoscopic Retrograde Cholangiopancreatography. 2019 Jan: 148-159. doi: 10.1016/B978-0-323-48109-0.00018-3. DOI: https://doi.org/10.1016/B978-0-323-48109-0.00018-3

Haseeb A and Freeman ML. Endoscopic Papillary Large Balloon Dilation Versus Endoscopic Sphincterotomy for Treatment of Bile Duct Stones. Current Treatment Options in Gastroenterology. 2019 Jun; 17: 221-30. doi: 10.1007/s11938-019-00234-5. DOI: https://doi.org/10.1007/s11938-019-00234-5

Cheng CL, Tang KP, Cheng SW, Fang HC, Shiue SJ, Suk FM et al. Comparison of Endoscopic Papillary Large‐Balloon Dilatation with Endoscopic Sphincterotomy in Clearing Large Common Bile Duct Stones: A Systematic Review and Meta‐Analysis of Randomized Controlled Trials. Advances in Digestive Medicine. 2022 Dec; 9(4): 221-8. doi: 10.1002/aid2.13295. DOI: https://doi.org/10.1002/aid2.13295

Alsenbesy M, Shahat K, Nawara A, Sallam M, Fakhry M, Shazly M et al. Endoscopic Papillary Large Balloon Dilatation (EPLBD) for the Extraction of Common Bile Duct Stones (CBDS). Rev. Esp. Enferm. Dig. 2019; 111. doi: 10.17235/reed.2019.5865/2018. DOI: https://doi.org/10.17235/reed.2019.5865/2018

Cotton PB, Eisen GM, Aabakken L, Baron TH, Hutter MM, Jacobson BC et al. A Lexicon for Endoscopic Adverse Events: Report of an ASGE Workshop. Gastrointestinal Endoscopy. 2010 Mar; 71(3): 446-54. doi: 10.1016/j.gie.2009.10.027. DOI: https://doi.org/10.1016/j.gie.2009.10.027

Ishii S, Isayama H, Ushio M, Takahashi S, Yamagata W, Takasaki Y, Suzuki A, Ochiai K, Tomishima K, Kanazawa R and Saito H. Best Procedure for the Management of Common Bile Duct Stones Via the Papilla: Literature Review and Analysis of Procedural Efficacy and Safety. Journal of Clinical Medicine. 2020 Nov; 9(12): 3808. doi: 10.3390/jcm9123808. DOI: https://doi.org/10.3390/jcm9123808

Ureña SY, Muente FS, Briceño JAB, Calderón AV, Arellano DS. Difficult or Complex Bile Duct Stones in ERCP: Large Balloon Dilation and Other Stone Management Methods. Accumulated Experience in A Referral Endoscopic Centre 2009-2018. Rev Gastroenterol Peru. 2021; 41(2): 94-102.

Amer AA, El-Feky AM, Abdalla EM, Soltan HM, Alabassy MM, Seddik RM. Endoscopic Papillary Large Balloon Dilation with or without Sphincterotomy for Extraction of Large Bile Duct Stones. Menoufia Medical Journal. 2022; 35(2): 716-21. doi: 10.4103/mmj.mmj_41_22. DOI: https://doi.org/10.4103/mmj.mmj_41_22

Kuo CM, Chiu YC, Liang CM, Wu CK, Lu LS, Tai WC et al. The Efficacy of Limited Endoscopic Sphincterotomy Plus Endoscopic Papillary Large Balloon Dilation for Removal of Large Bile Duct Stones. BioMed Central Gastroenterology. 2019 Dec; 19: 1-7. doi: 10.1186/s12876-019-1017-x. DOI: https://doi.org/10.1186/s12876-019-1017-x

Li T, Hao LX, Lv C, Li XJ, Ji XD, Chen M et al. Long-Term Outcomes of Endoscopic Papillary Large-Balloon Dilation (12–15 Mm) with or without Limited Sphincterotomy for Removal of Bile Duct Stones. Hepatobiliary & Pancreatic Diseases International. 2023 Aug; 22(4): 392-8. doi: 10.1016/j.hbpd.2022.07.003. DOI: https://doi.org/10.1016/j.hbpd.2022.07.003

Mohammed HI, Nada AS, Seddik RM, ElGazara AR. Combined Endoscopic Large Balloon Dilation with Limited Sphincterotomy Versus Sole Sphincterotomy for Removal of Large or Multiple Common Bile Duct Stones. Egyptian Liver Journal. 2023 Jan; 13(1): 1. doi: 10.1186/s43066-023-00235-1. DOI: https://doi.org/10.1186/s43066-023-00235-1