Journal d'hépatologie et des troubles gastro-intestinaux
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Prospective Controlled Randomized Study of Large-Balloon-Dilatation versus Mechanical Lithotripsy for Large Bile Duct Stone

Netinatsunton N, Attasaranya S, Pornpininworak K, Sottisuporn J, Witeerungrot T, Ovartlarnporn B, Suntharapornchai P, Jongbunyanuparp T and Geater A

Background: There were limited data of large balloon dilation (LBD) versus mechanical lithotripsy (ML) in large bile duct stone removal.

Aims: To compare the efficacy of sphincterotomy (EST) with LBD or ML in removal of stone with a transverse diameter ≥ 15 mm. Methods: 85 were prospectively randomized to EST-LBD (n=44) or EST- ML (n=41).

Results: The stone sizes were comparable (25.96+9.80 in EST-LBD vs. 24.75+8.30 mm in EST-ML, p=0.536). The initial stone clearance (ISC) rate was similar in both groups. The overall stone clearance (OSC) rate after ML rescue was 84.1% in ESTLBD and after LBD rescue was 80.5% in EST-ML (p=0.663). Stone >25 mm had lower ISC rate (50% versus 76.5% for stone 25 mm (84% vs. 42%, p=0.003). The mean procedure time was shorter in EST-LBD than EST-ML (13.26 vs. 19.39 minutes, p=0.036). The complication rates were comparable between EST-ML and EST-LBD (26.8% vs. 20.4%, p=0.489).

Conclusions: EST-LBD is as effective and safe as EST-ML for large stone removal with less time-consuming.