Abstract
Background Endoscopic papillary balloon dilation (EPBD) has a lower risk of hemorrhage than sphincterotomy and is easier to perform in altered/difficult anatomy. However, the sphincter of Oddi (SO) is only stretched but not cut after EPBD. Therefore, the biliary orifice is less opened, and failed stone extraction with EPBD alone occurs in up to 20% of patients. An uncut SO also may exacerbate pancreatic duct compression from edema after EPBD, and it increases the risk of pancreatitis. Objective To determine whether a longer duration for EPBD (5-minute vs conventional 1-minute) can further weaken the SO and reduce the rates of failed stone extraction and pancreatitis. Design Prospective, randomized trial. Setting Two tertiary-care referral centers. Patients This study involved 170 consecutive patients with common bile duct stones. Intervention EPBD for 1 minute (n = 86) or 5 minutes (n = 84). Main Outcome Measurements Failed stone extraction with EPBD alone and post-ERCP pancreatitis. Results Failed stone extraction with EPBD alone was less frequent with 5-minute EPBD (6 of 84, 7.1%) than with 1-minute EPBD (17 of 86, 19.8%), with a relative risk (RR) of 0.36 (P = .024). The risk of pancreatitis was also lower with 5-minute EPBD (4 of 84, 4.8%) than with 1-minute EPBD (13 of 86, 15.1%), with an RR of 0.32 (P = .038). Multivariable logistic regression analyses reaffirmed that 5-minute EPBD reduced the risk of failure with EPBD alone (odds ratio [OR] 0.19, P = .010) and pancreatitis (OR 0.28, P = .035). Limitations Endoscopists could not be blinded after the dilation durations were randomly assigned. Conclusion Compared with conventional 1-minute EPBD, 5-minute EPBD improves efficacy of stone extraction and reduces the risk of pancreatitis. (Clinical trial registration number: NCT00451581)
| Original language | English (US) |
|---|---|
| Pages (from-to) | 1154-1162 |
| Number of pages | 9 |
| Journal | Gastrointestinal Endoscopy |
| Volume | 72 |
| Issue number | 6 |
| DOIs | |
| State | Published - Dec 2010 |
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Keywords
- Abbreviations
- CBD
- CI
- Common bile duct
- Confidence interval
- Endoscopic papillary balloon dilation
- Endoscopic papillary large balloon dilation
- Endoscopic sphincterotomy
- EPBD
- EPLBD
- EST
- Odds ratio
- OR
- Relative risk
- RR
- SO
- Sphincter of Oddi
ASJC Scopus subject areas
- Gastroenterology
- Radiology Nuclear Medicine and imaging
Cite this
Randomized trial of 1-minute versus 5-minute endoscopic balloon dilation for extraction of bile duct stones. / Liao, Wei Chih; Lee, Ching Tai; Chang, Chi Yang; Leung, Joseph; Chen, Jiann Hwa; Tsai, Ming Chang; Lin, Jaw Town; Wu, Ming Shiang; Wang, Hsiu Po.
In: Gastrointestinal Endoscopy, Vol. 72, No. 6, 12.2010, p. 1154-1162.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Randomized trial of 1-minute versus 5-minute endoscopic balloon dilation for extraction of bile duct stones
AU - Liao, Wei Chih
AU - Lee, Ching Tai
AU - Chang, Chi Yang
AU - Leung, Joseph
AU - Chen, Jiann Hwa
AU - Tsai, Ming Chang
AU - Lin, Jaw Town
AU - Wu, Ming Shiang
AU - Wang, Hsiu Po
PY - 2010/12
Y1 - 2010/12
N2 - Background Endoscopic papillary balloon dilation (EPBD) has a lower risk of hemorrhage than sphincterotomy and is easier to perform in altered/difficult anatomy. However, the sphincter of Oddi (SO) is only stretched but not cut after EPBD. Therefore, the biliary orifice is less opened, and failed stone extraction with EPBD alone occurs in up to 20% of patients. An uncut SO also may exacerbate pancreatic duct compression from edema after EPBD, and it increases the risk of pancreatitis. Objective To determine whether a longer duration for EPBD (5-minute vs conventional 1-minute) can further weaken the SO and reduce the rates of failed stone extraction and pancreatitis. Design Prospective, randomized trial. Setting Two tertiary-care referral centers. Patients This study involved 170 consecutive patients with common bile duct stones. Intervention EPBD for 1 minute (n = 86) or 5 minutes (n = 84). Main Outcome Measurements Failed stone extraction with EPBD alone and post-ERCP pancreatitis. Results Failed stone extraction with EPBD alone was less frequent with 5-minute EPBD (6 of 84, 7.1%) than with 1-minute EPBD (17 of 86, 19.8%), with a relative risk (RR) of 0.36 (P = .024). The risk of pancreatitis was also lower with 5-minute EPBD (4 of 84, 4.8%) than with 1-minute EPBD (13 of 86, 15.1%), with an RR of 0.32 (P = .038). Multivariable logistic regression analyses reaffirmed that 5-minute EPBD reduced the risk of failure with EPBD alone (odds ratio [OR] 0.19, P = .010) and pancreatitis (OR 0.28, P = .035). Limitations Endoscopists could not be blinded after the dilation durations were randomly assigned. Conclusion Compared with conventional 1-minute EPBD, 5-minute EPBD improves efficacy of stone extraction and reduces the risk of pancreatitis. (Clinical trial registration number: NCT00451581)
AB - Background Endoscopic papillary balloon dilation (EPBD) has a lower risk of hemorrhage than sphincterotomy and is easier to perform in altered/difficult anatomy. However, the sphincter of Oddi (SO) is only stretched but not cut after EPBD. Therefore, the biliary orifice is less opened, and failed stone extraction with EPBD alone occurs in up to 20% of patients. An uncut SO also may exacerbate pancreatic duct compression from edema after EPBD, and it increases the risk of pancreatitis. Objective To determine whether a longer duration for EPBD (5-minute vs conventional 1-minute) can further weaken the SO and reduce the rates of failed stone extraction and pancreatitis. Design Prospective, randomized trial. Setting Two tertiary-care referral centers. Patients This study involved 170 consecutive patients with common bile duct stones. Intervention EPBD for 1 minute (n = 86) or 5 minutes (n = 84). Main Outcome Measurements Failed stone extraction with EPBD alone and post-ERCP pancreatitis. Results Failed stone extraction with EPBD alone was less frequent with 5-minute EPBD (6 of 84, 7.1%) than with 1-minute EPBD (17 of 86, 19.8%), with a relative risk (RR) of 0.36 (P = .024). The risk of pancreatitis was also lower with 5-minute EPBD (4 of 84, 4.8%) than with 1-minute EPBD (13 of 86, 15.1%), with an RR of 0.32 (P = .038). Multivariable logistic regression analyses reaffirmed that 5-minute EPBD reduced the risk of failure with EPBD alone (odds ratio [OR] 0.19, P = .010) and pancreatitis (OR 0.28, P = .035). Limitations Endoscopists could not be blinded after the dilation durations were randomly assigned. Conclusion Compared with conventional 1-minute EPBD, 5-minute EPBD improves efficacy of stone extraction and reduces the risk of pancreatitis. (Clinical trial registration number: NCT00451581)
KW - Abbreviations
KW - CBD
KW - CI
KW - Common bile duct
KW - Confidence interval
KW - Endoscopic papillary balloon dilation
KW - Endoscopic papillary large balloon dilation
KW - Endoscopic sphincterotomy
KW - EPBD
KW - EPLBD
KW - EST
KW - Odds ratio
KW - OR
KW - Relative risk
KW - RR
KW - SO
KW - Sphincter of Oddi
UR - http://www.scopus.com/inward/record.url?scp=78649509725&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=78649509725&partnerID=8YFLogxK
U2 - 10.1016/j.gie.2010.07.009
DO - 10.1016/j.gie.2010.07.009
M3 - Article
C2 - 20869710
AN - SCOPUS:78649509725
VL - 72
SP - 1154
EP - 1162
JO - Gastrointestinal Endoscopy
JF - Gastrointestinal Endoscopy
SN - 0016-5107
IS - 6
ER -