Samir Mrabti*, Ahlame Benhamdane, Asmae Sair, Tarik Addajou, Réda Berrida, Sara Sentissi, Ilham Koti, Fedoua Rouibaa, Ahmed Benkirane and Hassan Seddik

Hepato-gastroenterology Department II Mohammed V Military Instruction Hospital/Mohammed V University/Rabat/Morocco

*Corresponding Author: Samir Mrabti, Hepato-gastroenterology Department II Mohammed V Military Instruction Hospital/Mohammed V University/Rabat/Morocco.

Received: April 12, 2023; Published: May 29, 2023

Abstract

The aim of our study is to evaluate the efficacy and safety of sphincteroplasty and to study the factors influencing the success or failure of this technique.

Patients and Methods: This is a descriptive and analytical retrospective study conducted in our department between APRIL 2002 and DECEMBER 2022, including 52 patients who underwent sphincteroplasty for the extraction of a large bile duct stone. The success of the endoscopic treatment was defined by the complete emptiness of the common bile duct (CBD) at the end of the procedure. Statistical analysis was performed using SPSS version 24.0 software. The study of the factors associated with the success of endoscopic treatment was carried out using a logistic regression model.

Results: The average age of our patients was 65.37+/-17.46 years with a female predominance of 56.9%. The mean CBD diameter was 16 mm+/-2.97 [8-24 mm]. 16.51% of patients were cholecystectomized, 2% of patients had acute pancreatitis, on the other hand acute cholangitis was objectified in 9.8% of patients. 7.8% of patients had biliary stenosis and only one patient had periampullary diverticulum. The success rate of sphincteroplasty was 96.1% with no notable complications. None of the factors studied seemed to be associated with the success or failure of sphincteroplasty.

Conclusion: Macrodilation of the sphincter of oddi is a safe and effective technique in the treatment of large bile duct stones. In our study, the success rate was 96.1%, however none of the factors studied was associated with the success or failure of sphincteroplasty.

 Keywords: Large Stones; Common Bile Duct; Macrodilation of the Sphincter of Oddi

References

1. C H Oh and S H Dong. “Recent advances in the management of difficult bile-duct stones: a focus on single-operator cholangioscopy-guided lithotripsy”. Korean Journal of Internal Medicine 36 (2021): 235-246.
2. A Katanuma., et al. “ENDOSCOPIC TREATMENT OF DIFFICULT COMMON BILE DUCT STONES: DIFFICULT BILE DUCT STONES”. Digestive Endoscopy 22 (2010): S90-S97.
3. M Classen and L Demling. “Endoskopische Sphinkterotomie der Papilla Vateri und Steinextraktion aus dem Ductus choledochus”. DMW - Deutsche Medizinische Wochenschrift 99 (1974): 496-497.
4. K Kawai., et al. “Endoscopic sphincterotomy of the ampulla of Vater”. Gastrointestinal Endoscopic 20 (1974): 148-151.
5. G Stefanidis., et al. “Endoscopic extraction of large common bile duct stones: A review article”. World Journal Gastrointestinal Endoscopic 4 (2012): 167-179.
6. S Ishii., et al. “Best Procedure for the Management of Common Bile Duct Stones via the Papilla: Literature Review and Analysis of Procedural Efficacy and Safety”. Journal Clinics Medicine 9 (2020): 3808.
7. X M Yang., et al. “Endoscopic papillary large-balloon dilation following limited sphincterotomy for the removal of refractory bile duct stones: Experience of 169 cases in a single Chinese center: EPLBD facilitates stone removal”. Journal of Digestive Diseases 14 (2013): 125-131.
8. T Ogura and K Higuchi. “A review of treatment options for bile duct stones”. Expert Review of Gastroenterology and Hepatology 10 (2016): 1271-1278.
9. G Ersoz., et al. “Biliary sphinctrotomy plusdilation with a large ballon for bile duct stones that are difficult to extract”. Gastrointestinal Endoscopy 57 (2003): 156-159.
10. J H Kim., et al. “Endoscopic papillary large balloon dilation for the removal of bile duct stones”. World Journal of Gastroenterology: WJG 19 (2013): 8580-8594.
11. D K Lee and J H Jahng. “Alternative methods in the endoscopic management of difficult common bile duct stones: endoscopic management of CBD stones”. Digestive Endoscopy 22 (2010): S79-S84.
12. K Tsuchida., et al. “Comparison of the usefulness of endoscopic papillary large-balloon dilation with endoscopic sphincterotomy for large and multiple common bile duct stones”. BMC Gastroenterology 15 (2015): 59.
13. SJ Park., et al. “Factors Predictive of Adverse Events Following Endoscopic Papillary Large Balloon Dilation: Results from a Multicenter Series”. Digestive Diseases and Sciences 58 (2013): 1100-1109.
14. TH Kim., et al. “International consensus guidelines for endoscopic papillary large-balloon dilation”. Gastrointestinal Endoscopy 83 (2016): 37-47.
15. D Karsenti., et al. “Complete endoscopic sphincterotomy with vs. without large-balloon dilation for the removal of large bile duct stones: randomized multicenter study”. Endoscopy 49 (2017): 968-976.
16. G Grande., et al. “Dilation assisted stone extraction for complex biliary lithiasis: Technical aspects and practical principles”. World Journal of Gastrointestinal Endoscopy 13 (2021): 33-44.
17. KH Lai., et al. “Reappraisal of endoscopic papillary balloon dilation for the management of common bile duct stones”. World Journal of Gastrointestinal Endoscopy 7 (2015): 77-86.
18. G A Paspatis., et al. “Sixty- versus thirty-seconds papillary balloon dilation after sphincterotomy for the treatment of large bile duct stones: A randomized controlled trial”. Digestive and Liver Diseases 45 (2013): 301-304.
19. T H Kim., 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?”. Surgery Endoscopy 25 (2011): 3330-3337.
20. G Stefanidis., et al. “Large Balloon Dilation vs. Mechanical Lithotripsy for the Management of Large Bile Duct Stones: A Prospective Randomized Study”. American Journal of Gastroenterology 106 (2011): 278-285.
21. U I Aujla., et al. “Endoscopic papillary large balloon dilatation with sphincterotomy is safe and effective for biliary stone removal independent of timing and size of sphincterotomy”. World Journal of Gastroenterology 23 (2017): 8597-8604.
22. CM Kuo., et al. “The efficacy of limited endoscopic sphincterotomy plus endoscopic papillary large balloon dilation for removal of large bile duct stones”. BMC Gastroenterology 19 (2019): 93.
23. XD Xu., et al. “Minor endoscopic sphincterotomy followed by large balloon dilation for large choledocholith treatment”. World Journal of Gastroenterology 23 (2017): 5739-5745.
24. H G Kim., et al. “Small sphincterotomy combined with endoscopic papillary large balloon dilation versus sphincterotomy”. World Journal of Gastroenterology: WJG 15 (2009): 4298-4304.
25. H G Yoon., et al. “Endoscopic papillary large balloon dilation for the management of recurrent difficult bile duct stones after previous endoscopic sphincterotomy: EPLBD for recurrent difficult CBD stones”. Digestive Endoscopy 26 (2014): 259-263.
26. T Itoi., et al. “New large-diameter balloon-equipped sphincterotome for removal of large bile duct stones (with videos)”. Gastrointestinal Endoscopy 72 (2010): 825-830.
27. G A Paspatis., et al. “Long-term recurrence of bile duct stones after endoscopic papillary large balloon dilation with sphincterotomy: 4-year extended follow-up of a randomized trial". Surgical Endoscopy 31 (2017): 650-655.
28. Y Feng., et al. “Comparison of endoscopic papillary large balloon dilation and endoscopic sphincterotomy for retrieval of choledocholithiasis: a meta-analysis of randomized controlled trials”. Journal of Gastroenterology 47 (2012): 655-663.
29. B Maroy. "Life-threatening hemorrhage caused by balloon dilation after sphincterotomy for extraction of a large stone”. Endoscopy 43 (2011): 94-95.

Citation

Citation: Samir Mrabti., et al. “What is the Interest of Sphincteroplasty in the Treatment of Large Bile Duct Stones?". Acta Scientific Gastrointestinal Disorders 6.6 (2023): 25-30.

Copyright

Copyright: © 2023 Samir Mrabti., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.