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Randomized trial of 1-minute versus 5-minute endoscopic balloon dilation for extraction of bile duct stones.

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).

journal_name

Gastrointest Endosc

journal_title

Gastrointestinal endoscopy

authors

Liao WC,Lee CT,Chang CY,Leung JW,Chen JH,Tsai MC,Lin JT,Wu MS,Wang HP

doi

10.1016/j.gie.2010.07.009

subject

Has Abstract

pub_date

2010-12-01 00:00:00

pages

1154-62

issue

6

eissn

0016-5107

issn

1097-6779

pii

S0016-5107(10)01867-5

journal_volume

72

pub_type

杂志文章,多中心研究,随机对照试验

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