Long-term outcomes after endoscopic sphincterotomy versus endoscopic papillary balloon dilation for bile duct stones
Ichiro Yasuda, MD, PhD, Naotaka Fujita, MD, PhD, Hiroyuki Maguchi, MD, PhD, Osamu Hasebe, MD, PhD, Yoshinori Igarashi, MD, PhD, Akihiko Murakami, MD, PhD, Hidekazu Mukai, MD, PhD, Tsuneshi Fujii, MD, PhD, Kenji Yamao, MD, PhD, KenseiMaeshiro, MD, PhD, Tomoko Tada, MD, PhD, Takeshi Tsujino, MD, PhD, Yutaka Komatsu, MD, PhD Gifu, Sendai, Sapporo, Nagano, Tokyo, Morioka, Osaka, Asahikawa, Nagoya, Fukuoka, Japan
Objective: Endoscopic sphincterotomy (ES) is a well-established standard method for treating common bile duct stones. However, biliary sphincter function is impaired after the treatment, and this may inﬂuence the long-termoutcomes. In this study, we aimed to compare the long-term outcomes after ES with those after endoscopic papillary balloon dilation (EPBD) because the latter procedure is expected to preserve biliary sphincter function better than ES. Design: A prospective follow-up of the original cohort in a previously randomized, controlled trial to compare the early outcomes after ES and EPBD. Setting: Elevencenters, including 6 clinical practices and 5 academic institutions. Patients: A total of 282 patients with common bile duct stones were randomly selected to undergo ES (n or EPBD (n 138) in the previous study. Interventions: ES or EPBD. Main Outcome Measurements: Complications after ES or EPBD occurring during long-term follow-up. Results: The patients were followed up annually after the treatment.The median duration of the follow-up was 6.7 years. Morbidity was observed in 36 (25.0%) and 14 (10.1%) of the patients who underwent ES and EPBD, respectively (P .0016). Kaplan-Meier analysis revealed a signiﬁcantly higher incidence of biliary complications in the ES group than in the EPBD group (P .0011). Multivariate analysis showed that ES, periampullary diverticulum, and in situ gallbladderstones were independent risk factors for stone recurrence. Conclusions: During long-term follow-up, patients who underwent ES had signiﬁcantly more biliary complications than those who underwent EPBD. The biliary sphincter dysfunction after ES results in additional late complications. (Gastrointest Endosc 2010;72:1185-91.) 144)
Endoscopic sphincterotomy (ES) is currently used as a standardprocedure for the removal of common bile duct stones.1,2 However, the long-term outcomes after ES have not been sufﬁciently studied. ES causes a permanent reAbbreviations: EPBD, endoscopic papillary balloon dilation; ES, endoscopic sphincterotomy. DISCLOSURE: All authors disclosed no ﬁnancial relationships relevant to this publication. See CME section; p. 1249 Copyright © 2010 by the American Societyfor Gastrointestinal Endoscopy 0016-5107/$36.00 doi:10.1016/j.gie.2010.07.006 Received March 25, 2010. Accepted July 5, 2010. Current afﬁliations: First Department of Internal Medicine (I.Y.), Gifu University Hospital, Gifu, Department of Gastroenterology (N.F.), Sendai
duction in biliary sphincter function, and pneumobilia and duodenobiliary reﬂux are frequently observed.3,4 Reduced biliarysphincter function may cause clinical complications at a later stage.
City Medical Center, Sendai, Center for Gastroenterology (H.M.), TeineKeijinkai Hospital, Sapporo, Japan, Department of Gastroenterology (O.H.), Nagano Municipal Hospital, Nagano, Division of Gastroenterology (Y.I., T. Tada), Department of Internal Medicine, Toho University Ohashi Medical Center, Tokyo, Endoscopy Unit (A.M.),Iwate Prefectural Central Hospital, Morioka, Department of Gastroenterology (H.M.), Yodogawa Christian Hospital, Osaka, Department of Gastroenterology (T.F.), Asahikawa Kosei Hospital, Asahikawa, Department of Gastroenterology (K.Y.), Aichi Cancer Center Hospital, Nagoya, First Department of Surgery (K.M.), Fukuoka University School of Medicine, Fukuoka, Department of Gastroenterology (T. Tsujino,...