CC BY-NC-ND 4.0 · Endosc Int Open 2018; 06(02): E131-E138
DOI: 10.1055/s-0043-122493
Original article
Eigentümer und Copyright ©Georg Thieme Verlag KG 2018

Complex biliary stones management: cholangioscopy versus papillary large balloon dilation – a randomized controlled trial

Tomazo Franzini
University of Sao Paulo Medical School – Department of Gastroenterology, Sao Paulo, Brazil
,
Renata Nobre Moura
University of Sao Paulo Medical School – Department of Gastroenterology, Sao Paulo, Brazil
,
Priscilla Bonifácio
University of Sao Paulo Medical School – Department of Gastroenterology, Sao Paulo, Brazil
,
Gustavo Oliveira Luz
University of Sao Paulo Medical School – Department of Gastroenterology, Sao Paulo, Brazil
,
Thiago Ferreira de Souza
University of Sao Paulo Medical School – Department of Gastroenterology, Sao Paulo, Brazil
,
Marcos Eduardo Lera dos Santos
University of Sao Paulo Medical School – Department of Gastroenterology, Sao Paulo, Brazil
,
Gustavo Luis Rodela
University of Sao Paulo Medical School – Department of Gastroenterology, Sao Paulo, Brazil
,
Edson Ide
University of Sao Paulo Medical School – Department of Gastroenterology, Sao Paulo, Brazil
,
Paulo Herman
University of Sao Paulo Medical School – Department of Gastroenterology, Sao Paulo, Brazil
,
André Luis Montagnini
University of Sao Paulo Medical School – Department of Gastroenterology, Sao Paulo, Brazil
,
Luiz Augusto Carneiro D’Albuquerque
University of Sao Paulo Medical School – Department of Gastroenterology, Sao Paulo, Brazil
,
Paulo Sakai
University of Sao Paulo Medical School – Department of Gastroenterology, Sao Paulo, Brazil
,
Eduardo Guimarães Hourneaux de Moura
University of Sao Paulo Medical School – Department of Gastroenterology, Sao Paulo, Brazil
› Author Affiliations
Further Information

Publication History

submitted 18 January 2017

accepted after revision 25 October 2017

Publication Date:
01 February 2018 (online)

Abstract

Background and study aims Endoscopic removal of biliary stones has high success rates, ranging between 85 % to 95 %. Nevertheless, some stones may be challenging and different endoscopic methods have evolved. Papillary large balloon dilation after sphincterotomy is a widely used technique with success rates ranging from 68 to 90 % for stones larger than 15 mm. Cholangioscopy allows performing lithotripsy under direct biliary visualization, either by laser or electrohydraulic waves, which have similar success rate (80 % – 90 %). However, there is no study comparing these 2 techniques.

Patients and methods From April 2014 to June 2016, 100 patients were enrolled and randomized in 2 groups, using a non-inferiority hypothesis: cholangioscopy + electrohydraulic lithotripsy (group 1) and endoscopic papillary large balloon dilation (group 2). The main outcome was complete stone removal. Adverse events were documented. Mechanical lithotripsy was not performed. Failure cases had a second session with crossover of the methods.

Results The mean age was 56 years. 74 (75.5 %) patients were female. The initial overall complete stone removal rate was 74.5 % (77.1 % in group 1 and 72 % in group 2, P > 0.05). After second session the overall success rate achieved 90.1 %. Procedure time was significantly lower in group 2, – 25.2 min (CI95 % – 12.48 to – 37.91). There were no significant differences regarding technical success rate, radiologic exposure and adverse events.

Conclusion Single-operator cholangioscopy-guided lithotripsy and papillary large balloon dilation are effective and safe approaches for removing complex biliary stones.