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Endoscopic Papillary Balloon Dilation for Removal of Bile Duct Stones: Evaluation of Outcomes and Complications in 298 Patients

Background: Endoscopic papillary balloon dilation (EPBD) is a therapeutic procedure for extraction of bile duct stones. Goals: To evaluate the therapeutic outcomes, postoperative complications, and associated risk factors of EPBD in patients with bile duct stones. Study: A total of 298 patients with bile duct stones were treated with EPBD. Their immediate outcomes were assessed and they were followed up for late complications. The modified Cotton criteria were used to determine the incidence of post-EPBD pancreatitis. Results: Complete removal of bile duct stones was achieved in 273 patients (91.6%). Removal was successful in 94.6% of stones ⩽1 cm and 82.9% of stones >1 cm (P=0.001). Thirty patients (10.1%) had acute pancreatitis after EPBD with bile duct stone extraction, including 20 women (P=0.044), 20 patients under 60 years old (P=0.003) and 19 who received contrast medium injection to the pancreas (P=0.016). Symptomatic bile duct stones recurred in 12 patients (4%) 1 to 65 months after EPBD. The duration of balloon dilation was >3 minutes in 11 of these 12 patients (P=0.025) and all recurrent stones were brown and black pigment stones. Conclusions: EPBD is an effective and safe treatment for bile duct stone removal. Small bile duct stones (⩽1 cm) can easily be extracted by EPBD. Contrast medium injection to the pancreas, female sex, and age under 60 years were significant risk factors for post-EPBD pancreatitis. Balloon dilatation duration >3 minutes was the only risk factor for recurrent symptomatic bile duct stones.