Radiology

common bile duct calculi; Oddi's Sphincter; endoscopy; dilation

BACKGROUND
Endoscopic retrograde cholangiopancreatography (ERCP) is recommended by major guidelines for the removal of common bile duct (CBD) stones, but it is technically challenging in patients with low cardiopulmonary reserve and anatomical abnormalities of the upper gastrointestinal (GI) tract.
PURPOSE
To compare percutaneous transhepatic papillary balloon dilation (PTPBD) versus ERCP for CBD stones.
MATERIALS & METHODS
Participants with 1-3 CBD stones (largest stone at <=30 mm) without intrahepatic bile duct or gallbladder stones were eligible for this prospective cohort study. PTPBD was recommended to participants with low cardiopulmonary reserve or definitive anatomical abnormalities of the upper GI tract. Otherwise, both procedures were offered without preference. Follow-up, including abdominal CT, was conducted at 1st week, 1st, 3rd and 6th month, and every 6 months thereafter. Ultrasound and MR cholangiopancreatography were conducted if recurrence could not be confirmed with CT. Technical success rate was the primary outcome.
RESULTS
A total of 533 participants were included: 360 receiving PTPBD (median age: 76.5 years, IQR: 64-82, 163 men) and 173 receiving ERCP (median age: 66 years, IQR: 58-74, 94 men). The technical success rate was 98.6% (355/360) in PTPBD group and 96.5% (167/173) in ERCP group (relative risk 1.04, 1-sided 95%CI 1.00 to +∞; P=0.03). The incidence of overall complications was 3.6% (13/360) in PTPBD group and 7.5% (13/173) in ERCP group (relative risk 0.29, 95%CI 0.13 to 0.65; P=0.003). PTPBD group had a longer fluoroscopy time and a higher radiation exposure, with an adjusted difference of 31.2 min (95% CI 24.9 to 37.2) and 406.3 mGy (95% CI 322.8 to 489.9), respectively. A propensity score matching analysis (120 participants in each group) yielded similar results in technical success rate and complications.
CONCLUSION
In comparison to ERCP, PTPBD has a higher technical success rate, fewer perioperative complications, but a higher radiation exposure.

IF 11.105

Bin Liu

Yuliang

Article

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