Clinical efficacy of endoscopic sphincterotomy with small incision combined with endoscopic papillary balloon dilation in treatment of larger common bile duct stones_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 ZHENG Guilong , DING Haihua , DING Zhiqing , DENG Xianren

Department of General Surgery, The Second People’s Hospital of Zhenjiang City, Zhenjiang, Jiangsu 212002, P.R.China;

Corresponding author：

ZHENG Guilong, Email: zhengguilong@sohu.com

Keywords：

endoscopic sphincterotomy with small incision; endoscopic papillary balloon dilation; conventional endoscopic sphincterotomy; common bile duct stone

DOI：

10.7507/1007-9424.201607002

Video：

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Objective To investigate therapeutic effect of endoscopic sphincterotomy with small incision (SES) combined with endoscopic papillary balloon dilation (EPBD) in treatment of larger common bile duct stones. Methods The clinical data of 80 patients with common bile duct stones treated in our hospital from February 2014 to October 2015 were retrospectively analyzed. These patients were divided into endoscopic sphincterotomy (EST) group (n = 40) and SES+EPBD group (n = 40) according to the therapeutic methods. The diameter of common bile duct stone was 10–20 mm. The operation status, recurrence rate and residual rate of common bile duct stone, and complications rate within 3 months after operation were compared between these two groups. Results The age and gender had no significant differences between these two groups (P>0.05). The operation time was shorter (P<0.05) and the intraoperative bleeding was less (P<0.05) in the SES+EPBD group as compared with the EST group. There were no significant differences in the hospital stay and recovery time of gastrointestinal function between these two groups (P>0.05). The levels of ALT, AST, DBIL, and TBIL in these two groups before treatment had no significant differences (P>0.05); after treatment, the above indicators of liver function in the SES+EPBD group were significantly lower than those in the EST group (P<0.05), and which were significantly decreased more in the same group (P<0.05). The residual stone, stone recurrence, and complications such as acute pancreatitis, acute cholangitis, bile leakage and postoperative hemorrhage were not found in the SES+EPBD group, the rates of these indicators in the SES+EPBD group were significantly lower than those in the EST group (P<0.05). Conclusion SES combined with EPBD has a good therapeutic effect on larger common bile duct stones (diameter of common bile duct stone is 10–20 mm) and recurrence rate is low.

Citation： ZHENG Guilong, DING Haihua, DING Zhiqing, DENG Xianren. Clinical efficacy of endoscopic sphincterotomy with small incision combined with endoscopic papillary balloon dilation in treatment of larger common bile duct stones. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2017, 24(4): 474-477. doi: 10.7507/1007-9424.201607002 Copy

1.	庄文龙. 内镜下乳头括约肌切开术 (EST) 与内镜下乳头球囊扩张 (EPBD) 治疗老年胆总管结石患者的临床分析. 吉林大学, 2013.
2.	姜海行, 唐国都, 黄杰安, 等. 内镜下乳头括约肌切开术与球囊扩张术治疗胆总管结石的临床对照研究. 沈阳: 第七届全国 ERCP 学术研讨会暨 2014 胆胰疾病内镜诊疗新技术论坛大会, 2014.
3.	滕晓生, 李青松. 内镜下十二指肠乳头小切开联合乳头球囊扩张术治疗胆总管较大结石临床观察. 中华老年医学杂志, 2015, 34(3): 287-289.
4.	杨建锋, 王霞, 王晖, 等. 十二指肠乳头括约肌切开术对 Oddi 括约肌功能的影响及与远期并发症的关系. 中华消化内镜杂志, 2014, 31(1): 5-8.
5.	李俊景, 毕淑娟, 赵丹瑜, 等. 乳头括约肌切开术联合内镜下逆行胰胆管造影术内镜下治疗胆总管较大结石的护理配合. 中国药物与临床, 2015, 15(10): 1522-1523.
6.	赵昌杰, 陈林. 经内镜乳头括约肌小切开联合柱状球囊扩张术治疗胆总管结石 36 例分析. 中国临床研究, 2016, 29(1): 81-83.
7.	周春晓. 内镜下乳头肌小切开联合球囊扩张治疗老年胆总管结石的疗效分析. 肝胆外科杂志, 2015, 23(6): 409-412.
8.	黄永德, 何谦, 张诚华, 等. 内镜下 sEST + EPBD 治疗合并乳头旁憩室的胆总管结石临床分析. 现代中西医结合杂志, 2014, 23(18): 2008-2010.
9.	冯明明, 孙万日, 王庆元, 等. EST 治疗伴或不伴有胆石症的 Oddi 括约肌乳头狭窄. 中国普通外科杂志, 2014, 23(2): 250-253.
10.	何芳, 张光全, 李静. 两种胆总管结石手术的临床疗效比较. 胃肠病学和肝病学杂志, 2014, 23(8): 934-936.
11.	凌峰. 乳头括约肌小切口联合球囊扩张治疗胆总管结石的疗效及安全性. 现代消化及介入诊疗, 2014, 19(6): 388-389.
12.	王毓彬, 陈双东. EST + EPBD 治疗胆总管结石的效果分析. 肝胆外科杂志, 2014, 22(3): 210-213.
13.	Kim KH, Rhu JH, Kim TN. Recurrence of bile duct stones after endoscopic papillary large balloon dilation combined with limited sphincterotomy: long-term follow-up study. Gut Liver, 2012, 6(1): 107-112.
14.	Guo SB, Meng H, Duan ZJ,et al. Small sphincterotomy combined with endoscopic papillary large balloon dilationvs sphincterotomy alone for removal of common bile duct stones. World J Gastroenterol, 2014, 20(47): 17962-17969.
15.	潘俊, 董卫国, 刘敏, 等. ERCP 中 SEST 联合 EPBD 对比单纯 EST 对胆总管结石取石的临床分析. 胃肠病学和肝病学杂志, 2015, 24(3): 341-343.
16.	Ishii K, Itoi T, Itokawa F,et al. Post-endoscopic retrograde cholangiopancreatography pancreatitis caused by papillary large-balloon dilation of incidental intrapapillary fistula in Roux-en-Y patients: lesson from a case. Dig Endosc, 2014, 26 Suppl 2: 144-146.
17.	张莉, 吴瑜, 秦鸣放. 胆总管下端良性狭窄患者内镜下十二指肠乳头括约肌切开术前后 Oddi 括约肌压力变化的分析. 中国内镜杂志, 2014, 20(11): 1165-1167.
18.	张节, 李能平, 张亚运, 等. 内镜下不同大小气囊扩张十二指肠乳头治疗胆总管结石近远期效果的研究. 中华消化内镜杂志, 2015, 32(8): 534-539.
19.	朱玲玲, 张健康. EST 小切开联合 EPBD 治疗胆总管结石合并乳头旁憩室的临床分析. 中国医学创新, 2016, 13(4): 46-49.
20.	Trikudanathan G, Arain MA, Attam R,et al. Advances in the endoscopic management of common bile duct stones. Nat Rev Gastroenterol Hepatol, 2014, 11(9): 535-544.
21.	Kataoka K, Aoyama I, Mizusawa J,et al. A randomized controlled phase Ⅱ/Ⅲ study comparing endoscopic balloon dilation combined with steroid injection versus radial incision and cutting combined with steroid injection for refractory anastomotic stricture after esophagectomy: Japan Clinical Oncology Group Study JCOG1207. Jpn J Clin Oncol, 2015, 45(4): 385-389.
22.	Veitch AM, Vanbiervliet G, Gershlick AH,et al. Endoscopy in patients on antiplatelet or anticoagulant therapy, including direct oral anticoagulants: British Society of Gastroenterology (BSG) and European Society of Gastrointestinal Endoscopy (ESGE) guidelines. Gut, 2016, 65(3): 374-389.
23.	张楷, 詹峰, 张云, 等. 腹腔镜再次胆道手术治疗胆总管结石. 中华肝胆外科杂志, 2014, 20(4): 265-268.
24.	Lai KH, Chan HH, Tsai TJ,et al. Reappraisal of endoscopic papillary balloon dilation for the management of common bile duct stones. World J Gastrointest Endosc, 2015, 7(2): 77-86.
25.	周贤斌, 叶丽萍, 张玉, 等. 内镜下乳头括约肌小切开联合球囊扩张术治疗肝硬化合并胆总管结石的疗效观察. 中华消化内镜杂志, 2014, 31(12): 708-712.

1. 庄文龙. 内镜下乳头括约肌切开术 (EST) 与内镜下乳头球囊扩张 (EPBD) 治疗老年胆总管结石患者的临床分析. 吉林大学, 2013.
2. 姜海行, 唐国都, 黄杰安, 等. 内镜下乳头括约肌切开术与球囊扩张术治疗胆总管结石的临床对照研究. 沈阳: 第七届全国 ERCP 学术研讨会暨 2014 胆胰疾病内镜诊疗新技术论坛大会, 2014.
3. 滕晓生, 李青松. 内镜下十二指肠乳头小切开联合乳头球囊扩张术治疗胆总管较大结石临床观察. 中华老年医学杂志, 2015, 34(3): 287-289.
4. 杨建锋, 王霞, 王晖, 等. 十二指肠乳头括约肌切开术对 Oddi 括约肌功能的影响及与远期并发症的关系. 中华消化内镜杂志, 2014, 31(1): 5-8.
5. 李俊景, 毕淑娟, 赵丹瑜, 等. 乳头括约肌切开术联合内镜下逆行胰胆管造影术内镜下治疗胆总管较大结石的护理配合. 中国药物与临床, 2015, 15(10): 1522-1523.
6. 赵昌杰, 陈林. 经内镜乳头括约肌小切开联合柱状球囊扩张术治疗胆总管结石 36 例分析. 中国临床研究, 2016, 29(1): 81-83.
7. 周春晓. 内镜下乳头肌小切开联合球囊扩张治疗老年胆总管结石的疗效分析. 肝胆外科杂志, 2015, 23(6): 409-412.
8. 黄永德, 何谦, 张诚华, 等. 内镜下 sEST + EPBD 治疗合并乳头旁憩室的胆总管结石临床分析. 现代中西医结合杂志, 2014, 23(18): 2008-2010.
9. 冯明明, 孙万日, 王庆元, 等. EST 治疗伴或不伴有胆石症的 Oddi 括约肌乳头狭窄. 中国普通外科杂志, 2014, 23(2): 250-253.
10. 何芳, 张光全, 李静. 两种胆总管结石手术的临床疗效比较. 胃肠病学和肝病学杂志, 2014, 23(8): 934-936.
11. 凌峰. 乳头括约肌小切口联合球囊扩张治疗胆总管结石的疗效及安全性. 现代消化及介入诊疗, 2014, 19(6): 388-389.
12. 王毓彬, 陈双东. EST + EPBD 治疗胆总管结石的效果分析. 肝胆外科杂志, 2014, 22(3): 210-213.
13. Kim KH, Rhu JH, Kim TN. Recurrence of bile duct stones after endoscopic papillary large balloon dilation combined with limited sphincterotomy: long-term follow-up study. Gut Liver, 2012, 6(1): 107-112.
14. Guo SB, Meng H, Duan ZJ,et al. Small sphincterotomy combined with endoscopic papillary large balloon dilationvs sphincterotomy alone for removal of common bile duct stones. World J Gastroenterol, 2014, 20(47): 17962-17969.
15. 潘俊, 董卫国, 刘敏, 等. ERCP 中 SEST 联合 EPBD 对比单纯 EST 对胆总管结石取石的临床分析. 胃肠病学和肝病学杂志, 2015, 24(3): 341-343.
16. Ishii K, Itoi T, Itokawa F,et al. Post-endoscopic retrograde cholangiopancreatography pancreatitis caused by papillary large-balloon dilation of incidental intrapapillary fistula in Roux-en-Y patients: lesson from a case. Dig Endosc, 2014, 26 Suppl 2: 144-146.
17. 张莉, 吴瑜, 秦鸣放. 胆总管下端良性狭窄患者内镜下十二指肠乳头括约肌切开术前后 Oddi 括约肌压力变化的分析. 中国内镜杂志, 2014, 20(11): 1165-1167.
18. 张节, 李能平, 张亚运, 等. 内镜下不同大小气囊扩张十二指肠乳头治疗胆总管结石近远期效果的研究. 中华消化内镜杂志, 2015, 32(8): 534-539.
19. 朱玲玲, 张健康. EST 小切开联合 EPBD 治疗胆总管结石合并乳头旁憩室的临床分析. 中国医学创新, 2016, 13(4): 46-49.
20. Trikudanathan G, Arain MA, Attam R,et al. Advances in the endoscopic management of common bile duct stones. Nat Rev Gastroenterol Hepatol, 2014, 11(9): 535-544.
21. Kataoka K, Aoyama I, Mizusawa J,et al. A randomized controlled phase Ⅱ/Ⅲ study comparing endoscopic balloon dilation combined with steroid injection versus radial incision and cutting combined with steroid injection for refractory anastomotic stricture after esophagectomy: Japan Clinical Oncology Group Study JCOG1207. Jpn J Clin Oncol, 2015, 45(4): 385-389.
22. Veitch AM, Vanbiervliet G, Gershlick AH,et al. Endoscopy in patients on antiplatelet or anticoagulant therapy, including direct oral anticoagulants: British Society of Gastroenterology (BSG) and European Society of Gastrointestinal Endoscopy (ESGE) guidelines. Gut, 2016, 65(3): 374-389.
23. 张楷, 詹峰, 张云, 等. 腹腔镜再次胆道手术治疗胆总管结石. 中华肝胆外科杂志, 2014, 20(4): 265-268.
24. Lai KH, Chan HH, Tsai TJ,et al. Reappraisal of endoscopic papillary balloon dilation for the management of common bile duct stones. World J Gastrointest Endosc, 2015, 7(2): 77-86.
25. 周贤斌, 叶丽萍, 张玉, 等. 内镜下乳头括约肌小切开联合球囊扩张术治疗肝硬化合并胆总管结石的疗效观察. 中华消化内镜杂志, 2014, 31(12): 708-712.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Clinical efficacy of endoscopic sphincterotomy with small incision combined with endoscopic papillary balloon dilation in treatment of larger common bile duct stones

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