One-step transfistula large versus conventional balloon dilation following precut fistulotomy in difficult biliary cannulation for the removal of biliary stones: a multicenter retrospective study.

Abstract

BACKGROUND AND AIM: After selective biliary access following precut fistulotomy

in difficult biliary cannulations (DBC), there are several methods of completely

opening the remaining papillary roof for the removal of biliary stones. We

evaluated the efficacy of one-step transfistula balloon dilation following

fistulotomy in DBC for the removal of biliary stones. METHODS: This retrospective

multicenter study was performed in four tertiary referral centers. Patients who

underwent fistulotomy due to DBC were enrolled. Precut fistulotomy followed by

conventional (</= 10 mm) or large balloon (>/= 12 mm) dilation through the

fistulotomy tract was performed to remove biliary stones. The main outcome

measures were technical success and transfistula balloon dilation-related

complications. RESULTS: A total of 154 patients were enrolled. Large balloon and

conventional balloon dilation were performed in 57 and 97 patients, respectively.

The primary technical success of stone removal was 100% (57/57) for large balloon

dilation and 96.9% (94/97) for conventional balloon dilation (P = 0.296). The

mean procedure time from biliary access to removal of stones was 29.3 min in

large balloon and 22.2 min in conventional balloon dilation (P = 0.042), and the

mean numbers of endoscopic retrograde cholangiopancreatography sessions were 1.4

and 1.3, respectively (P = 0.175). Transfistula balloon dilation-related

complications were not different between the two groups (10.5% in large balloon

dilation vs 16.5% in conventional balloon dilation, P = 0.307). CONCLUSIONS:

One-step transfistula balloon dilation following precut fistulotomy in DBC may be

safe and effective for the removal of biliary stones. There were no differences

in therapeutic outcomes and complications between large and conventional balloon

dilation.