不进行括约肌切开术的内镜下乳头大球囊扩张和内镜下乳头球囊扩张清除胆总管巨大结石：一项倾向性匹配分析
摘要：
目的：
不进行括约肌切开术(EST)的内镜乳头大球囊扩张术(EPLBD)可通过充分扩张壶腹来促进胆总管巨大结石的取出。然而，与内镜下乳头球囊扩张(EPBD)术后良好的远期结果相反，对未进行EST的EPLBD的研究较少。因此，我们进行了一项研究，以评估未进行EST和EPBD的EPLBD在清除胆总管巨大结石(LBDS；≥10 mm)的近期和远期疗效。
方法：对未有过EST、EPBD或EPLBD病史的、不进行EST或EPBD而是直接采用EPLBD治疗胆总管巨大结石的患者进行回顾性研究。未进行EST的EPLBD组的患者与EPBD组的患者使用倾向评分进行匹配。
结果：对每组44例患者进行配对分析。倾向匹配后，平衡基线特征。未进行EST的EPLBD组的单次取石成功率较高(80%vs16%，P<0.001)，ERCP次数(1.3±0.74比2.4±1.5，P<0.001)和碎石使用率(30%比80%，P<0.001)较低。与早期不良事件组间的零差异相反（P=0.99），未进行EST的EPLBD组晚期胆道并发症(胆管炎、胆囊炎、肝脓肿）的累积发生率高于EPBD组(P=0.02)。
结论：未进行EST的EPLBD组对胆总管巨大结石的清除率较高，但与EPBD组相比，其远期预后较差。
Endoscopic papillary large balloon dilation and endoscopic papillary balloon dilation both without sphincterotomy for removal of large bile duct stones: a propensity-matched analysis
Ryunosuke Hakuta, Shuhei Kawahata, Hirofumi Kogure，et al.
Abstract
Objectives:
Endoscopic papillary larger balloon dilation (EPLBD) without endoscopic sphincterotomy (EST) may facilitate extraction of large bile duct stones through achieving adequate dilation of the ampulla. However, contrary to favorable long-term outcomes after endoscopic papillary balloon dilation (EPBD), that of EPLBD without EST has been little investigated. Therefore, we conducted a current study to evaluate short- and long-term outcomes of EPLBD without EST and EPBD after removal of large bile duct stones (LBDS; ≥ 10mm).
Methods:This retrospective study included patients without a previous history of EST, EPBD or EPLBD who underwent EPLBD without EST or EPBD for removal of LBDS. Each patient in the EPLBD without EST group was matched to a patient in the EPBD group using propensity scores.
Results: Forty-four patients in each group were matched for the analysis. The baseline characteristics were balanced after propensity matching. The rate of complete stone removal in a single session was higher (80% vs. 16%, P < 0.001), and the number of ERCP sessions (1.3 ± 0.74 vs. 2.4 ± 1.5, P < 0.001) and the rate of lithotripsy use (30% vs. 80%, P < 0.001) were smaller in the matched EPLBD without EST group. Contrary to null between-group differences in early adverse events (P = 0.99), a cumulative rate of late biliary complications was higher in EPLBD without EST group (P = 0.02).
Conclusions:EPLBD without EST showed higher efficacy for removal of LBDS but was associated with worse long-term outcomes when compared to EPBD.
翻译：胡越 审校：张立超、侯森林
