Endoscopic balloon dilation compared with sphincterotomy for extraction of bile duct stones

James A. Disario, Martin L. Freeman, David J. Bjorkman, Padraic MacMathuna, Bret T. Petersen, Philip E. Jaffe, Thomas G. Morales, Lee J. Hixson, Stuart Sherman, Glen Lehman, M. Mazen Jamal, Firas H. Al-Kawas, Mukul Khandelwal, Joseph P. Moore, Gregory A. Derfus, Priya A. Jamidar, Francisco C. Ramirez, Michael E. Ryan, Karen L. Woods, David L. Carr-Locke & 1 others Stephen C. Alder

Research output: Contribution to journalArticle

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Abstract

Background & Aims: Endoscopic retrograde cholangiopancreatography is commonly performed to remove bile duct stones. The aim of this study was to determine short-term outcomes of endoscopic balloon dilation of the sphincter of Oddi compared with sphincterotomy for stone extraction. Methods: A randomized, controlled multicenter study of 117 patients assigned to dilation and 120 to sphincterotomy was performed in a spectrum of clinical and academic practices. Results: Characteristics of the patients, procedures, and endoscopists were similar except that dilation patients were younger. Procedures were successful in 97.4% and 92.5% of the dilation and sphincterotomy patients, respectively. Overall morbidity occurred in 17.9% and 3.3% (P <. 001; difference, 14.6; 95% confidence interval, 7-22.3) and severe morbidity, including 2 deaths, in 6.8% and 0%(P <. 004; difference, 6.8; 95% confidence interval, 2.3-11.4) for dilation and sphincterotomy, respectively. Complications for dilation and sphincterotomy, respectively, included: pancreatitis, 15.4% and. 8% (P <. 001; difference, 14.6; 95% confidence interval, 7.8-21.3); cystic duct fistula, 1.7% and 0%; cholangitis,. 9% and. 8%; perforation, 0% and. 8%; and cholecystitis, 0% and. 8%. There were 2 deaths (1.7%) due to pancreatitis following dilation and none with sphincterotomy. The study was terminated at the first interim analysis. Dilation patients required significantly more invasive procedures, longer hospital stays, and longer time off from normal activities. Conclusions: In a broad spectrum of patients and practices, endoscopic balloon dilation compared with sphincterotomy for biliary stone extraction is associated with increased short-term morbidity rates and death due to pancreatitis. Balloon dilation of the sphincter of Oddi for stone extraction should be avoided in routine practice.

Original languageEnglish
Pages (from-to)1291-1299
Number of pages9
JournalGastroenterology
Volume127
Issue number5
DOIs
StatePublished - Nov 2004

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Bile Ducts
Dilatation
Pancreatitis
Sphincter of Oddi
Confidence Intervals
Morbidity
Cystic Duct
Cholecystitis
Cholangitis
Endoscopic Retrograde Cholangiopancreatography
Multicenter Studies
Fistula
Length of Stay
Mortality

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Disario, J. A., Freeman, M. L., Bjorkman, D. J., MacMathuna, P., Petersen, B. T., Jaffe, P. E., ... Alder, S. C. (2004). Endoscopic balloon dilation compared with sphincterotomy for extraction of bile duct stones. Gastroenterology, 127(5), 1291-1299. https://doi.org/10.1053/j.gastro.2004.07.017

Endoscopic balloon dilation compared with sphincterotomy for extraction of bile duct stones. / Disario, James A.; Freeman, Martin L.; Bjorkman, David J.; MacMathuna, Padraic; Petersen, Bret T.; Jaffe, Philip E.; Morales, Thomas G.; Hixson, Lee J.; Sherman, Stuart; Lehman, Glen; Jamal, M. Mazen; Al-Kawas, Firas H.; Khandelwal, Mukul; Moore, Joseph P.; Derfus, Gregory A.; Jamidar, Priya A.; Ramirez, Francisco C.; Ryan, Michael E.; Woods, Karen L.; Carr-Locke, David L.; Alder, Stephen C.

In: Gastroenterology, Vol. 127, No. 5, 11.2004, p. 1291-1299.

Research output: Contribution to journalArticle

Disario, JA, Freeman, ML, Bjorkman, DJ, MacMathuna, P, Petersen, BT, Jaffe, PE, Morales, TG, Hixson, LJ, Sherman, S, Lehman, G, Jamal, MM, Al-Kawas, FH, Khandelwal, M, Moore, JP, Derfus, GA, Jamidar, PA, Ramirez, FC, Ryan, ME, Woods, KL, Carr-Locke, DL & Alder, SC 2004, 'Endoscopic balloon dilation compared with sphincterotomy for extraction of bile duct stones', Gastroenterology, vol. 127, no. 5, pp. 1291-1299. https://doi.org/10.1053/j.gastro.2004.07.017
Disario JA, Freeman ML, Bjorkman DJ, MacMathuna P, Petersen BT, Jaffe PE et al. Endoscopic balloon dilation compared with sphincterotomy for extraction of bile duct stones. Gastroenterology. 2004 Nov;127(5):1291-1299. https://doi.org/10.1053/j.gastro.2004.07.017
Disario, James A. ; Freeman, Martin L. ; Bjorkman, David J. ; MacMathuna, Padraic ; Petersen, Bret T. ; Jaffe, Philip E. ; Morales, Thomas G. ; Hixson, Lee J. ; Sherman, Stuart ; Lehman, Glen ; Jamal, M. Mazen ; Al-Kawas, Firas H. ; Khandelwal, Mukul ; Moore, Joseph P. ; Derfus, Gregory A. ; Jamidar, Priya A. ; Ramirez, Francisco C. ; Ryan, Michael E. ; Woods, Karen L. ; Carr-Locke, David L. ; Alder, Stephen C. / Endoscopic balloon dilation compared with sphincterotomy for extraction of bile duct stones. In: Gastroenterology. 2004 ; Vol. 127, No. 5. pp. 1291-1299.
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abstract = "Background & Aims: Endoscopic retrograde cholangiopancreatography is commonly performed to remove bile duct stones. The aim of this study was to determine short-term outcomes of endoscopic balloon dilation of the sphincter of Oddi compared with sphincterotomy for stone extraction. Methods: A randomized, controlled multicenter study of 117 patients assigned to dilation and 120 to sphincterotomy was performed in a spectrum of clinical and academic practices. Results: Characteristics of the patients, procedures, and endoscopists were similar except that dilation patients were younger. Procedures were successful in 97.4{\%} and 92.5{\%} of the dilation and sphincterotomy patients, respectively. Overall morbidity occurred in 17.9{\%} and 3.3{\%} (P <. 001; difference, 14.6; 95{\%} confidence interval, 7-22.3) and severe morbidity, including 2 deaths, in 6.8{\%} and 0{\%}(P <. 004; difference, 6.8; 95{\%} confidence interval, 2.3-11.4) for dilation and sphincterotomy, respectively. Complications for dilation and sphincterotomy, respectively, included: pancreatitis, 15.4{\%} and. 8{\%} (P <. 001; difference, 14.6; 95{\%} confidence interval, 7.8-21.3); cystic duct fistula, 1.7{\%} and 0{\%}; cholangitis,. 9{\%} and. 8{\%}; perforation, 0{\%} and. 8{\%}; and cholecystitis, 0{\%} and. 8{\%}. There were 2 deaths (1.7{\%}) due to pancreatitis following dilation and none with sphincterotomy. The study was terminated at the first interim analysis. Dilation patients required significantly more invasive procedures, longer hospital stays, and longer time off from normal activities. Conclusions: In a broad spectrum of patients and practices, endoscopic balloon dilation compared with sphincterotomy for biliary stone extraction is associated with increased short-term morbidity rates and death due to pancreatitis. Balloon dilation of the sphincter of Oddi for stone extraction should be avoided in routine practice.",
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T1 - Endoscopic balloon dilation compared with sphincterotomy for extraction of bile duct stones

AU - Disario, James A.

AU - Freeman, Martin L.

AU - Bjorkman, David J.

AU - MacMathuna, Padraic

AU - Petersen, Bret T.

AU - Jaffe, Philip E.

AU - Morales, Thomas G.

AU - Hixson, Lee J.

AU - Sherman, Stuart

AU - Lehman, Glen

AU - Jamal, M. Mazen

AU - Al-Kawas, Firas H.

AU - Khandelwal, Mukul

AU - Moore, Joseph P.

AU - Derfus, Gregory A.

AU - Jamidar, Priya A.

AU - Ramirez, Francisco C.

AU - Ryan, Michael E.

AU - Woods, Karen L.

AU - Carr-Locke, David L.

AU - Alder, Stephen C.

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