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Which Is the Better Treatment for the Removal of Large Biliary Stones? Endoscopic Papillary Large Balloon Dilation versus Endoscopic Sphincterotomy

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Background/Aims: We evaluated the efficacy and costeffectivenessof endoscopic papillary large balloon dilation(EPLBD) for large common bile duct (CBD) stone removalcompared with endoscopic sphincterotomy (EST). Methods:A total of 1,580 patients who underwent endoscopic CBDstone extraction between January 2001 and July 2010 werereviewed. The following inclusion criteria were applied: choledocholithiasistreated by EPLBD with minor EST or EST withmechanical lithotripsy; and follow-up >9 months after treatment. Results: Forty-nine patients with EPLBD and 41 withEST were compared. There was no significant difference inthe complication rates and stone recurrence rates betweenthe two groups. However, significantly more endoscopic retrogradecholangiopancreatography (ERCP) sessions wererequired in the EST group to achieve the complete removalof stones (1.7 times vs 1.3 times; p=0.03). The mean costrequired for complete stone removal per patient was significantlyhigher in the EST group compared to the EPLBD group(USD $1,644 vs $1,225, respectively; p=0.04). Dilated CBDwas the only significant factor associated with recurrentbiliary stones (relative risk, 1.09; 95% confidence interval,1.02 to 1.17; p=0.02). Conclusions: EPLBD is the bettertreatment (compared to EST) for removing large CBD stonesbecause EPLBD requires fewer ERCP sessions and is lessexpensive

Abstract

Background/Aims: We evaluated the efficacy and costeffectivenessof endoscopic papillary large balloon dilation(EPLBD) for large common bile duct (CBD) stone removalcompared with endoscopic sphincterotomy (EST). Methods:A total of 1,580 patients who underwent endoscopic CBDstone extraction between January 2001 and July 2010 werereviewed. The following inclusion criteria were applied: choledocholithiasistreated by EPLBD with minor EST or EST withmechanical lithotripsy; and follow-up >9 months after treatment. Results: Forty-nine patients with EPLBD and 41 withEST were compared. There was no significant difference inthe complication rates and stone recurrence rates betweenthe two groups. However, significantly more endoscopic retrogradecholangiopancreatography (ERCP) sessions wererequired in the EST group to achieve the complete removalof stones (1.7 times vs 1.3 times; p=0.03). The mean costrequired for complete stone removal per patient was significantlyhigher in the EST group compared to the EPLBD group(USD $1,644 vs $1,225, respectively; p=0.04). Dilated CBDwas the only significant factor associated with recurrentbiliary stones (relative risk, 1.09; 95% confidence interval,1.02 to 1.17; p=0.02). Conclusions: EPLBD is the bettertreatment (compared to EST) for removing large CBD stonesbecause EPLBD requires fewer ERCP sessions and is lessexpensive

참고문헌 (34)

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