내시경 유두괄약근 절개술과 큰 풍선 유두 확장술을 병용한 거대 담관결석의 치료

Abstract

Background/Aims: The extraction of large common bile duct (CBD) stones after an endoscopic sphincterotomy (EST) is successful in 80∼90% of cases but it often requires a prolonged time and repeated trials. This study investigated the utility of a combined endoscopic papillary large balloon dilatation (EPLBD) and a mid-incision of an EST (m-EST) method for the removal of large CBD stones. Methods: Thirty patients with large CBD stones were enrolled in this study. EPLBD was carried out using the one-step inflation of a 15∼18 mm diameter balloon after m-EST. Results: The maximum stone diameter was 21.62±5.38 mm. Twelve patients had more than 4 stones, 7 patients had 2 stones, and the remainder had a single large stone. Complete ductal clearance was achieved in all patients. After the procedure, the serum amylase and/or lipase levels were elevated in 3 patients (13.3%). However, there was no episode of true pancreatitis. Minor bleeding was encountered in only one patient (3.3%), and was easily controlled by an endoscopic epinephrine injection. The procedure was carried out safely in 6 patients with periampullary diverticulum. No perforation or mortality was encountered. Conclusions: Combined EPLBD and m-EST is a safe and effective method, and may be a good alternative treatment for removing large CBD stones.