A prospective study on endoscopic papillary balloon dilatation and mechanical lithotripsy in treatment of choledocholithiasis: dilatation or lithotripsy first

doi:10.16139/j.1007-9610.2022.03.006

Abstract

Abstract:

Objective To investigate endoscopic retrograde cholangiopancreatography (ERCP) in the treatment of large common bile duct stone with endoscopic papillary balloon dilatation (EPBD) first or mechanical lithotripsy first. EPBD first or lithotripsy first were compared for stone removal efficiency and post-ERCP complications. Methods A prospective study of 40 patients with choledocholithiasis from January 2021 to January 2022 was done. Patients were divided into lithotripsy first group and EPBD first group each 20 cases using random number table. Stone remove time, stone removal efficiency (cm³/min), the rate of residual stones and rate of post-ERCP pancreatitis were compared between two groups. Results All cases underwent stone removal one time successfully. There was no statistically significant difference in maximum diameter of stone, single or multiple stone, stone volumes (cm³), time for stone remove and operative time between two groups. The stone removal efficiency (cm³/min) in lithotripsy first group was significantly higher than that in EPBD first group, (0.91±0.58) cm³/min vs. (0.51±0.17) cm³/min, P=0.048. While the procedure numbers of stone tool passing papilla in lithotripsy first group were less than those in EPBD first group, (4.9±1.7) vs. (7.9±2.2), P=0.021. The differences in the rate of residual stone and the rate of post-ERCP complications were not significant statistically. Post-ERCP serum amylase level [(196±158) U/L vs. (332±265) U/L, P=0.02] and the cases with hyperamylasemia (2 cases vs. 8 cases, P=0.028) in lithotripsy first group were significantly lower than those in EPBD first group. No case with severe pancreatitis,gastrointestinal bleeding or duodenal perforation occurred in either group. Conclusions Using lithotripsy before EPBD procedure in treatment of difficult common bile duct stone could increase stone removal efficiency and reduce both procedure number of stone tool passing papilla and rate of post-ERCP hyperamylasemia.

Key words: Endoscopic retrograde cholangiopancreatography, Choledocholithiasis, Mechanical lithotripsy, Endoscopic papillary balloon dilatation

CLC Number:

R657.42

WENG Hao, WENG Mingzhe, SHU Yijun, GU Jun, ZHANG Wenjie, WANG Xuefeng. A prospective study on endoscopic papillary balloon dilatation and mechanical lithotripsy in treatment of choledocholithiasis: dilatation or lithotripsy first[J]. Journal of Surgery Concepts & Practice, 2022, 27(03): 210-214.

Figures/Tables 2

References 8

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组别	先碎后扩（n=20）	先扩后碎（n=20）	χ²/t值	P值
性别（男/女）	9/11	8/12	0.102	0.749
年龄（岁）	73.5±10.7	71.2±9.7	0.619	0.437
术前总胆红素（μmol/L）	61.7±47.5	60.9±40.3	0.058	0.809
术前丙氨酸转氨酶（U/L）	148±112	134±124	0.366	0.478
术前白细胞计数（×10⁹/L）	9.55±4.13	9.59±4.62	-0.031	0.519

组别	先碎后扩（n=20）	先扩后碎（n=20）	χ²/t值	P值
插管时间（min）	2.5±5.5	4.8±7.7	-1.063	0.271
进入胰管（是/否）	3/17	4/16	0.000	1.000
针状刀预切开（是/否）	1/19	1/19	0.000	1.000
结石最大径（cm）	1.7±0.6	1.7±0.4	0.200	0.201
结石数量（单发/多发）	6/14	7/13	0.114	0.736
结石总体积（cm³）	7.4±4.6	7.2±3.8	0.162	0.372
取石时间（min）	9.8±6.3	15.7±11.5	-2.017	0.411
取石效率（cm³/min）	0.91±0.58	0.51±0.17	2.976	0.048
扩张球囊直径（cm）	1.16±0.15	1.18±0.06	-0.737	0.129
操作时间（min）	26.9±11.5	39.1±19.9	-2.376	0.311
取石器械进出乳头次数	4.9±1.7	7.9±2.2	-4.789	0.021
放置胰管支架（是/否）	2/18	2/18	0.000	1.000
术后24 h淀粉酶水平（U/L）	196±158	332±265	-1.971	0.02
ERCP术后胰腺炎（是/否）	1/19	2/18	0.000	1.000
术后高淀粉酶血症（是/否）	2/18	8/12	4.800	0.028
结石残留（是/否）	2/18	3/17	0.000	1.000

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