Endoscopic sphincter dilation in patients with bile duct stones: Immediateand medium-term results

Background: Endoscopic sphincter dilation (ESD) is believed to successfully treat bile duct stones without serious procedure-related complications. Methods: We evaluated the efficacy, safety and limitations of this relative ly new procedure in a consecutive series of patients to establish the clini cal role of this modality for treating bile duct stones. One hundred and fo rty-three consecutive patients were treated by ESD between July 1995 and Ma rch 1998. The balloons used were a Maxforce 5-Fr or Olbert 5-Fr balloon-tip ped catheter with a maximal diameter of 8 mm. Mechanical lithotriptor (ML) or extracorporeal shock wave lithotripsy (ESWL) were used when stones were large and/or numerous and a Dormia basket or retrievable balloon catheter w as used to extract the stones entirely. Procedure-related symptoms and chem ical data after the procedure were monitored during and after ESD at least until the following morning. To diagnose residual stones accurately, intrad uctal ultrasonography was routinely used. Results: Although the majority of patients complained of subtle pain during balloon inflation and demonstrated oozing during and after balloon inflati on, the procedures were well tolerated. Complete stone extraction was achie ved in 139 (97.2%) of the patients. Mechanical lithotriptor and ESWL were u sed to assist stone clearance in 79 (55.2%) and 23 (16.1%) patients, respec tively Mild pancreatitis occurred in six patients (4.2%). However, there we re no other serious complications. Stone recurrence was identified in six p atients and these stones were re-extracted by subsequent ESD procedures. Conclusions: A high success rate for stone extraction and the relative safe ty of this procedure was confirmed. However, there was recurrence in a rela tively high percentage of patients within a short period and this may be a forthcoming issue in ESD. Long-term follow-up observation and the establish ment Of countermeasures for stone recurrence seem to be essential. (C) 1999 Blackwell Science Asia Pty Ltd.