Endoscopic large-diameter balloon dilation after fistulotomy for the removal of bile duct stones in a difficult cannulation - 23/08/11
Reprint requests: Chang-Hwan Park, MD, PhD, Division of Gastroenterology, Department of Internal Medicine, Chonnam National University Medical School, 8 Hak-dong, Dong-ku, Gwangju, 501-757, Korea.Gwangju, South Korea
Abstract |
Background |
When standard methods of biliary cannulation fail, needle-knife fistulotomy may be used. However, large stones cannot be easily extracted through the necessarily smaller opening made when using the fistulotomy technique.
Objective |
We report the efficacy and safety of endoscopic large-diameter balloon dilation after fistulotomy for the removal of bile duct stones in patients in whom cannulation is difficult.
Design |
A case series.
Setting |
A tertiary referral center.
Patients and Interventions |
Six patients (6 of 115, 5.2%) with bile duct stones in whom cannulation by the conventional method had failed underwent fistulotomy and large-diameter (12-15 mm) balloon dilation through the fistulotomy tract.
Main Outcome Measurements |
Successful biliary cannulation, outcome of therapy, and post-ERCP complications including pancreatitis were recorded.
Results |
Biliary cannulation was successful in 6 of 6 patients (100%) with fistulotomy. After endoscopic large-diameter balloon dilation of the fistulotomy tract, stone extraction was successfully performed in 6 of 6 patients. None of the patients developed post-ERCP pancreatitis. One of the 6 patients had minor delayed bleeding, which stopped spontaneously.
Limitations |
A small case series, retrospective design, and no control group.
Conclusion |
Endoscopic large-diameter balloon dilation through the fistulotomy tract may be a feasible and safe alternative method for the removal of bile duct stones in patients in whom cannulation is difficult.
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| DISCLOSURE: All authors disclosed no financial relationships relevant to this publication. |
Vol 69 - N° 4
P. 955-959 - aprile 2009 Ritorno al numero
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