Efficacy and safety of minor endoscopic sphincterotomy combined with endoscopic papillary large balloon dilation in treatment of elderly patients with multiple large common bile duct stones

Objective To investigate the clinical effect and safety of minor endoscopic sphincterotomy (m EST) combined with endoscopic papillary large balloon dilation (EPLBD) in the treatment of elderly patients with multiple large common bile duct stones.Methods A retrospective analysis was performed for 229 patients with multiple large common bile duct stones who underwent endoscopic retrograde cholangiopancreatography (ERCP) in Endoscopy Center, Ankang Municipal Central Hospital, from January 2012 to December 2016, and the surgical procedure was selected based on the size of stones and the morphology of the common bile duct.According to the endoscopic surgical procedure, the patients were divided into m EST + EPLBD group (treatment group with 136 patients) and endoscopic phincterotomy (EST) group (control group with 93 patients) .The two groups were compared in terms of the success rate of first stone removal, use rate of mechanical lithotripsy (ML) , time spent on stone removal, and the incidence rate of complications.The t-test was used for comparison of continuous data between groups, and the chi-square test was used for comparison of categorical data between groups.Results There was no significant difference in the success rate of first stone removal between the treatment group and the control group (91.17% vs 87.10%, χ2=0.980, P > 0.05) , while there were significant differences in the time spent on stone removal (18.2 ± 4.3 min vs 37.4 ± 6.7 min, χ2=37.1526, P < 0.01) and use rate of ML (6.71% vs 40.00%, t = 24.411, P < 0.01) .There were no significant differences in the incidence rates of pancreatitis (2.94% vs 6.45%, χ2= 1.630, P > 0.05) and bleeding (2.21% vs 2.15%, χ2= 0.001, P > 0.05) between the two groups, and no patient experienced perforation or infection.Conclusion m EST + EPLBD has a good clinical effect in the treatment of elderly patients with multiple large common bile duct stones and can effectively shorten the time spent on stone removal, reduce the use rate of ML, and thus reduce the recurrence rate of stones.In addition, this method does not increase post-ERCP complications and is a safe and effective therapeutic method for multiple large common bile duct stones in elderly patients.