Comparing the treatment outcomes of endoscopic papillary dilation and endoscopic sphincterotomy for removal of bile duct stones

To compare the clinical usefulness of endoscopic papillary dilation (EPD) a nd endoscopic sphincterotomy (EST) for removal of bile duct stones, 110 pat ients with stones up to 15 mm in diameter and less than 10 in number were r andomly treated with either EPD (55 patients) or BST (55 patients). The pat ients were followed up for a median period of 23 months and endoscopic mano metry with the administration of morphine was carried out in 17 patients wh o were observed more than 12 months after the procedures to evaluate the po st-procedure papillary function. Duct clearance was achieved in 51 EPD (92. 7%) and 54 EST patients (98.1%, not significantly different). Forty EPD (78 .4%) and 51 EST patients (94.4%) achieved duct clearance in the initial pro cedure (P = 0.02). Early complications occurred in one EPD (2.0%) and in th ree EST patients (5.6%, P=0.62). Complications during the follow-up period occurred in two EPD and eight EST patients. Recurrence of bile duct stones was observed in two EPD and three EST patients (P=0.98). Acute cholecystiti s was observed in one EPD and five EST patients (P=0.06) and among patients with gall-bladder stones in situ, the rate of acute cholecystitis after EP D was significantly lower than that after EST (P=0.03). Endoscopic manometr y showed the existence of a choledochoduodenal pressure gradient only after EPD, while papillary contractile function was observed after both procedur es. In conclusion, both EPD and EST are safe therapeutic modalities, althou gh EPD is more clinically effective in decreasing the risk of acute cholecy stitis in patients with gallbladder stones Dr situ and in preserving post-p rocedure papillary function.