PAPILLARY DILATION VS SPHINCTEROTOMY IN ENDOSCOPIC REMOVAL OF BILE-DUCT STONES - A RANDOMIZED TRIAL WITH MANOMETRIC FUNCTION

To circumvent the long-term effects of papillary ablation for extracti ng common bile duct stones (<12 mm in diameter) in endoscopic sphincte rotomy (EST), endoscopic papillary dilation (EPD) was attempted in 20 patients. To evaluate papillary function before and after the procedur es, manometry of the sphincter of Oddi was carried out in 13 with EPD and 10 of 20 patients with EST. Extraction of all stones was successfu l (100%) in both groups at an equal rate. Repeated numbers of procedur es were common in both groups. However, the mean duration of the proce dure was high in EPD compared to EST (63 min vs 42 min, P < NS). Adjun ctive therapies like mechanical lithotripsy (ML), nasobiliary drainage , and choledochoscopy were included in EPD, while EST required a baske t catheter and ML. There was no significant difference on manometry be fore and after the procedures (P = NS), although papillary function wa s found to have decreased after the EPD. In contrast, all patients in the EST group lost papillary function after the procedure. Thirty-day morbidity and mortality rate were absent in both groups. Immediate and 2.5-year follow up complications were uncommon in both groups. As a s imple method, EPD may be an effective and safe alternative to EST in t he management of patients with bile duct stones who require maintenanc e of papillary function.