Endoscopic papillary large balloon dilation reduces relapse in recurrent common bile duct stones

Stone recurrence arises following traditional endoscopic retrograde cholangiopancreatography (ERCP) in nearly half of the patients with recurrent common bile duct stone (CBDS) during long-term follow-up, reports a recent study.

“Our study was the first to show that endoscopic papillary large balloon dilation (EPLBD) effectively reduced the recurrence of CBDS,” the investigators said.

Consecutive patients with recurrent CBDS were randomized 1:1 to either the EPLBD group or the control group. The CBDS recurrence rate within 2 years after ERCP was the primary outcome. The investigators employed an intention-to-treat analysis.

One hundred eight patients with recurrent CBDS were enrolled from 2014 to 2021, with 90 randomized into each treatment group. All patients went through a complete CBDS clearance by one or several sessions of ERCP.

The EPLBD group had a significantly higher rate of complete clearance in one session than the control group (95.6 percent vs 85.6 percent; p=0.017) during follow-up. Patients in the EPLBD group had a significantly lower CBDS recurrence rate within 2 years than controls (21.1 percent vs 36.7 percent; relative risk, 0.58, 95 percent confidence interval [CI], 0.36‒0.93; p=0.021).

Over a median follow-up of 56 months, CBDS recurrence developed in 34.4 percent of patients in the EPLBD group and 51.1 percent of those in the control group (hazard ratio, 0.57, 95 percent CI, 0.36‒0.89; p=0.012). Moreover, the EPLBD group had greater reductions in multiple recurrences than did controls (4.4 percent vs 18.9 percent; p=0.020).

“Up to 60 percent of patients with CBDS recurrence suffer from further recurrence after ERCP,” the investigators said. “There are no effective methods to prevent recurrence in most patients.”