Comparative efficacy and safety of three endoscopic techniques for the treatment of large common bile duct stones (≥ 15 mm): Long-term follow-up

Abstract

Background & aims: The effectiveness of endoscopic papillary large balloon dilation (EPLBD) alone versus EPLBD combined with endoscopic sphincterotomy (EST) in treating large common bile duct stones (CBDS, ≥ 15 mm) remains unclear. This study aimed to evaluate the safety and treatment outcomes of EPLBD combined with limited or large EST versus EPLBD alone in removing large CBDS.

Methods: Between January 2013 and September 2024, 408 patients underwent EPLBD, either alone or in combination with EST, to treat large CBDS (≥ 15 mm). The patients were divided into three groups: EPLBD alone (n = 92), EPLBD with limited EST (n = 124), and EPLBD with large EST (n = 192). The study compared the first-session stone clearance rate, overall stone success rate, mechanical lithotripsy (ML) use, and adverse event rate.

Results: Compared to the EPLBD alone group, the EPLBD with limited EST and the EPLBD with large EST groups demonstrated higher initial stone clearance rates, required fewer endoscopic procedures for complete stone removal, and had lower rates of ML use and CBDS recurrence. Compared to the EPLBD with limited EST group, the EPLBD with large EST group showed a higher initial stone clearance rate, fewer endoscopic procedures required for complete CBDS removal, and no significant differences in adverse events. The multivariate analysis demonstrated that the endoscopic technique and number of endoscopic operations were strongly associated with the CBDS recurrence.

Conclusions: EPLBD combined with large EST may represent a more rational endoscopic technique for treating large CBDS.

Keywords: Clinical outcomes; Endoscopic papillary large balloon dilatation; Endoscopic sphincterotomy; Large common bile duct stones; Recurrence.