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The EPLBD for clearance of difficult biliary stones is effective, safe and reduces mechanical lithotripsy requirement although the risk factors for failure and complications associated with this technique still unclear.
To determine risk factors for failure and complications of EPLBD in the clearance of difficult bile duct stones.
Prospective cohort study. Patients: with difficult bile duct stones defined according to stone and anatomic bile duct features. Intervention: sphincterotomy followed by large balloon dilation (ES-LBD) (Balloon diameter: 12–20mm). Failure: unsuccessful clearance of difficult bile duct stones in a single procedure. Complications: Appeared within 30 days post EPLBD.
There were included 188 patients (age: 73.74 ±14.22 years old, 41.5% women) who underwent ES-LBD due to difficult choledocholitiasis (n =181) or anatomic biliary problems (n =7). Diameter of largest stone: 13.3 ±4.3mm. Distal common bile duct (CBD) diameter thinner than proximal CBD: 8%. Failure rate: 13.3%. In a multivariate analysis, the stone diameter larger than distal CBD/sphincterotomy: OR =3.52 (1.38 – 8.99 CI95%) and the diameter of largest stone ≥13mm: OR =5.03 (1.53 – 16.52 CI95%) were associated to failure. Complication rate: 11.2%. Hemorrhage was the most frequent complication: 7.98% although greater than one third of them were mild and resolved during the same ERCP. The age <78 years old: OR =3.07 (1.04 – 9.01 CI95%); distal CBD diameter thinner than proximal CBD: OR =11.73 (3.02 – 42.9 CI95%), and the use of a balloon diameter ≥15mm: OR =5.54 (1.55 – 19.69 CI95%) were associated to the appearance of complications.
The stone diameter larger than distal CBD/sphincterotomy and the diameter of largest stone ≥13mm are risk factors for failure of EPLBD in the clearance of difficult bile duct stones. In the same way, the age <78 years old, distal CBD diameter thinner than proximal CBD and the use of a balloon diameter ≥15mm are risk factors for the appearance of complications.