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《国际消化病杂志》[ISSN:1673-534X/CN:31-1953/R]

期数:

2024年03期

页码:

165-170

栏目:

论著

出版日期:

2024-06-25

文章信息/Info

Title:

Long-term efficacy analysis of limited endoscopic sphincterotomy with large balloon dilation and endoscopic duodenal papillary sphincterotomye for treatment of common bile duct stones?

作者:

李涛; 郝立校; 吕婵; 吴静怡; 李兴佳; 王永明; 陈萌; 纪晓丹; 刘畅; 别里克; 龚彪

201203 上海中医药大学附属曙光医院消化科（李涛、郝立校、吕婵、吴静怡、李兴佳、王永明、陈萌、纪晓丹、刘畅、龚彪）, 200025 上海交通大学医学院附属瑞金医院消化科（别里克）

Author(s):

LI Tao;  HAO Lixiao;  LYU Chan;  WU Jingyi;  LI Xingjia;  WANG Yongming;  CHEN Meng;  JI Xiaodan;  LIU Chang;  GONG Biao; BIE Like

LI Tao, HAO Lixiao, LYU Chan, WU Jingyi, LI Xingjia, WANG Yongming, CHEN Meng, JI Xiaodan, LIU Chang, GONG Biao. Department of Gastroenterology, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China; BIE Like. Department of Gastroenterology, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200025, China

关键词:

内镜下十二指肠乳头括约肌切开术; 内镜下十二指肠乳头括约肌小切开联合大球囊扩张术; 胆总管结石

Keywords:

Endoscopic duodenal papillary sphincterotomye;  Limited endoscopic sphincterotomy with large balloon dilation;  Common bile duct stones

分类号:

-

DOI:

10.3969/j.issn.1673-534X.2024.03.006

文献标识码:

-

摘要:

目的比较内镜下十二指肠乳头括约肌小切开联合大球囊扩张术（ESLBD）（12～15mm）与内镜下十二指肠乳头括约肌切开术（EST）治疗难治性胆总管结石的远期疗效。方法选择2009年1月至2020年1月在上海交通大学医学院附属瑞金医院和上海中医药大学附属曙光医院消化内镜中心采用EST或ESLBD（12～15mm）治疗的131例难治性胆总管结石患者，分为EST组（n＝70）和ESLBD组（n＝61），比较2组的完全取石成功率、经内镜逆行胰胆管造影术（ERCP）相关术后近期并发症及远期并发症发生率等指标。结果EST组和ESLBD组的取石成功率和机械碎石率差异均无统计学意义（98.6%比100.0%，24.3%比18.0%，P均＞0.05）。EST组的ERCP术后近期并发症发生率高于ESLBD组（8.6%比3.3%），但差异无统计学意义（P＞0.05）。长期随访结果显示，EST组和ESLBD组的ERCP术后远期并发症发生率差异无统计学意义（11.9%比8.6%，P＞0.05）。结论与EST相比，ESLBD（12～15mm）用于治疗难治性胆总管结石是安全有效的，尤其是对于合并十二指肠乳头旁憩室、凝血功能障碍等患者，ESLBD可作为首选治疗方法。EST与ESLBD的术后远期并发症发生率相似，ESLBD也会造成十二指肠乳头括约肌功能损伤。

Abstract:

Objective? This paper aims to compare the long-term efficacy of limited endoscopic sphincterotomy with large balloon dilation (ESLBD) and endoscopic duodenal papillary sphincterotomye (EST) for the treatment of common bile duct stones. Methods? A hundred and thirty-one patients with common bile duct stones treated with EST or ESLBD (12-15 mm) at the Digestive Endoscopy Center of Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, and Shuguang Hospital, Shanghai University of Traditional Chinese Medicine from January 2009 to January 2020 were selected and assigned to the EST group (n＝70) and the ESLBD group (n＝61). The success rate of complete stone removal, and the incidence of recent and long-term complications after endoscopic retrograde cholangiopancreatography (ERCP) were compared between the two groups. Results? There is no statistically significant difference in the success rate of stone extraction and mechanical fragmentation between the EST group and the ESLBD group (98.6% versus 100.0%, 24.3% versus 18.0%, and P＞0.05). The incidence of recent complications after ERCP in the EST group is higher than that in the ESLBD group (8.6% versus 3.3%), but the difference is not statistically significant (P＞0.05). The long-term follow-up results show that there is no statistically significant difference in the incidence of long-term complications after ERCP between the EST group and the ESLBD group (11.9% versus 8.6%, and P＞0.05). Conclusions? Compared with EST, ESLBD (12-15 mm) is a safe and effective treatment for common bile duct stones. Especially for special patients with concomitant duodenal papillary diverticulum and coagulation dysfunction, ESLBD can be the preferred treatment method. The incidence of long-term postoperative complications in EST and ESLBD is similar, and ESLBD can also cause varying degrees of damage to the function of the duodenal papillary sphincter.

参考文献/References

1 Cotton PB, Lehman G, Vennes J, et al. Endoscopic sphincterotomy complications and their management: an attempt at consensus[J]. Gastrointest Endosc, 1991, 37(3): 383-393.
2Liu Y, Su P, Lin S, et al. Endoscopic papillary balloon dilatation versus endoscopic sphincterotomy in the treatment for choledocholithiasis: a meta-analysis[J]. J Gastroenterol Hepatol, 2012, 27(3): 464-471.
3Ersoz G, Tekesin O, Ozutemiz AO, et al. Biliary sphincterotomy plus dilation with a large balloon for bile duct stones that are difficult to extract[J]. Gastrointest Endosc, 2003, 57(2): 156-159.
4Tsuchida K, Iwasaki M, Tsubouchi M, et al. Comparison of the usefulness of endoscopic papillary large-balloon dilation with endoscopic sphincterotomy for large and multiple common bile duct stones[J]. BMC Gastroenterol, 2015, 15: 59.
5Rebelo A, Ribeiro PM, Correia AP, et al. Endoscopic papillary large balloon dilation after limited sphincterotomy for difficult biliary stones[J]. World J Gastrointest Endosc, 2012, 4(5): 180-184.
6Teoh AYB, Cheung FKY, Hu B, et al. Randomized trial of endoscopic sphincterotomy with balloon dilation versus endoscopic sphincterotomy alone for removal of bile duct stones[J]. Gastroenterology, 2013, 144(2): 341-345. e1.
7Stefanidis G, Viazis N, Pleskow D, et al. Large balloon dilation vs. mechanical lithotripsy for the management of large bile duct stones: a prospective randomized study[J]. Am J Gastroenterol, 2011, 106(2):278-285.
8Cotton PB, Eisen GM, Aabakken L, et al. A lexicon for endoscopic adverse events: report of an ASGE workshop[J]. Gastrointest Endosc, 2010, 71(3): 446-454.
9Rosa B, Moutinho Ribeiro P, Rebelo A, et al. Endoscopic papillary balloon dilation after sphincterotomy for difficult choledocholithiasis:A case-controlled study[J]. World J Gastrointest Endosc, 2013, 5(5):211-218.
10 Kim TH, Oh HJ, Lee JY, et al. Can a small endoscopic sphincterotomy plus a large-balloon dilation reduce the use of mechanical lithotripsy in patients with large bile duct stones?[J]. Surg Endosc, 2011, 25(10):3330-3337.
11 Attasaranya S, Cheon YK, Vittal H, et al. Large-diameter biliary orifice balloon dilation to aid in endoscopic bile duct stone removal: a multicenter series[J]. Gastrointest Endosc, 2008, 67(7): 1046-1052.
12 de Clemente Junior CC, Bernardo WM, Franzini TP, et al. Comparison between endoscopic sphincterotomy vs endoscopic sphincterotomy associated with balloon dilation for removal of bile duct stones: A systematic review and meta-analysis based on randomized controlled trials[J]. World J Gastrointest Endosc, 2018, 10(8): 130-144.
13 Youn YH, Lim HC, Jahng JH, et al. The increase in balloon size to over 15 mm does not affect the development of pancreatitis after endoscopic papillary large balloon dilatation for bile duct stone removal[J]. Dig Dis Sci, 2011, 56(5): 1572-1577.
14 Jeong S, Ki SH, Lee DH, et al. Endoscopic large-balloon sphincteroplasty without preceding sphincterotomy for the removal of large bile duct stones: a preliminary study[J]. Gastrointest Endosc, 2009, 70(5): 915-922.
15 Park JS, Jeong S, Bang BW, et al. Endoscopic papillary large balloon dilatation without sphincterotomy for the treatment of large common bile duct stone: Long-term outcomes at a single center[J]. Dig Dis Sci, 2016, 61(10): 3045-3053.
16 Kogure H, Tsujino T, Isayama H, et al. Short- and long-term outcomes of endoscopic papillary large balloon dilation with or without sphincterotomy for removal of large bile duct stones[J]. Scand J Gastroenterol, 2014, 49(1): 121-128.
17 Kim JH, Yang MJ, Hwang JC, et al. Endoscopic papillary large balloon dilation for the removal of bile duct stones[J]. World J Gastroenterol, 2013, 19(46): 8580-8594.
18 Lee TH, Park SH, Lee CK, et al. Life-threatening hemorrhage following large-balloon endoscopic papillary dilation successfully treated with angiographic embolization[J]. Endoscopy, 2009, 41 Suppl 2: E241-E242.
19 Fujita N, Maguchi H, Komatsu Y, et al. Endoscopic sphincterotomy and endoscopic papillary balloon dilatation for bile duct stones: A prospective randomized controlled multicenter trial[J]. Gastrointest Endosc, 2003, 57(2): 151-155.
20 Geenen DJ, Geenen JE, Jafri FM, et al. The role of surveillance endoscopic retrograde cholangiopancreatography in preventing episodic cholangitis in patients with recurrent common bile duct stones[J]. Endoscopy, 1998, 30(1): 18-20.
21 Tanaka M, Takahata S, Konomi H, et al. Long-term consequence of endoscopic sphincterotomy for bile duct stones[J]. Gastrointest Endosc, 1998, 48(5): 465-469.
22 Hawes RH, Cotton PB, Vallon AG. Follow-up 6 to 11 years after duodenoscopic sphincterotomy for stones in patients with prior cholecystectomy[J]. Gastroenterology, 1990, 98(4): 1008-1012.
23 Tanaka S, Sawayama T, Yoshioka T. Endoscopic papillary balloon dilation and endoscopic sphincterotomy for bile duct stones: long-term outcomes in a prospective randomized controlled trial[J]. Gastrointest Endosc, 2004, 59(6): 614-618.
24 Prat F, Malak NA, Pelletier G, et al. Biliary symptoms and complications more than 8 years after endoscopic sphincterotomy for choledocholithiasis[J]. Gastroenterology, 1996, 110(3): 894-899.
25 Hisatomi K, Ohno A, Tabei K, et al. Effects of large-balloon dilation on the major duodenal papilla and the lower bile duct: histological evaluation by using an ex vivo adult porcine model[J]. Gastrointest Endosc, 2010, 72(2): 366-372.
26 Cheon YK, Lee TY, Kim SN, et al. Impact of endoscopic papillary large-balloon dilation on sphincter of Oddi function: a prospective randomized study[J]. Gastrointest Endosc, 2017, 85(4): 782-790. e1.

备注/Memo

备注/Memo:

通信作者：龚彪，Email: gbercp616@163.com

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更新日期/Last Update: 2024-06-25