未行内镜下括约肌切开术（EST）的内镜下乳头大球囊扩张术（EPLBD），可通过充分扩张壶腹部促进胆管巨大结石的取出。然而，与内镜下乳头球囊扩张术（EPBD）后良好的长期预后相反，未行EST的EPLBD的研究很少。因此，我们进行了本研究，以评估未行EST的EPLBD和EPBD在治疗胆管巨大结石（LBDS；≥10 mm）后的短期和长期疗效。这项回顾性研究包括既往无EST、EPBD或EPLBD病史的患者，他们接受了无EST的EPLBD或EPBD来治疗LBDS。未行EST组的EPLBD患者通过倾向性评分与EPBD组的患者相匹配。每组44名患者进行配对分析。倾向性匹配后的基线特征是平衡的。未行EST组的EPLBD患者单次取石率较高（80%vs 16%，p<0.001），ERCP次数（1.3±0.7 vs 2.4±1.5，p<0.001）和碎石使用率（30%vs 80%，p<0.001）均较少。与组间早期不良事件的无差异（p=0.99）相反，未行EST组的EPLBD患者晚期胆道并发症的累积率更高（p=0.02）。未行EST的EPLBD对LBDS的清除率较高，但与EPBD相比，其长期疗效较差。
Endoscopic papillary large balloon dilation and endoscopic papillary balloon dilation both without sphincterotomy for removal of large bile duct stones: A propensity-matched analysis.
Hakuta R, Kawahata S, Kogure H,al.Dig Endosc. 2019 Jan;31(1):59-68
Endoscopic papillary large 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 the current study to evaluate short- and long-term outcomes of EPLBD without EST and EPBD after removal of large bile duct stones (LBDS; ≥10 mm). 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. Forty-four patients in each group were matched for the analysis. Baseline characteristics were balanced after propensity matching.Rate of complete stone removal in a single session was higher (80% vs 16%, P < 0.001), number of ERCP sessions (1.3 ± 0.7 vs 2.4 ± 1.5, P < 0.001) and 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 the EPLBD without EST group (P = 0.02). EPLBD without EST showed higher efficacy for removal of LBDS but was associated with worse long-term outcomes when compared to EPBD.
Ryunosuke H , Shuhei K , Hirofumi K , et al. Endoscopic papillary large balloon dilation and endoscopic papillary balloon dilation both without sphincterotomy for removal of large bile duct stones: a propensity-matched analysis[J]. Digestive Endoscopy, 2018.