Endoscopy 2020; 52(S 01): S12
DOI: 10.1055/s-0040-1704044
ESGE Days 2020 oral presentations
Thursday, April 23, 2020 16:30 – 18:00 ERCP for biliary stones Liffey Hall 2
© Georg Thieme Verlag KG Stuttgart · New York

EFFICACY AND SAFETY OF DILATION-ASSISTED STONE EXTRACTION (DASE) AFTER ENDOSCOPIC SPHINCTEROTOMY (EST) FOR DIFFICULT BILIARY STONES: DATA FROM A SERIES IN A SINGLE REFERRAL CENTER

D Scimeca
1   ARNAS Civico - Di Cristina - Benfratelli Hospital, Gastroenterology and Endoscopy Unit, Palermo, Italy
,
ML Mastro
1   ARNAS Civico - Di Cristina - Benfratelli Hospital, Gastroenterology and Endoscopy Unit, Palermo, Italy
,
F Mocciaro
1   ARNAS Civico - Di Cristina - Benfratelli Hospital, Gastroenterology and Endoscopy Unit, Palermo, Italy
,
A Bonaccorso
1   ARNAS Civico - Di Cristina - Benfratelli Hospital, Gastroenterology and Endoscopy Unit, Palermo, Italy
,
E Conte
1   ARNAS Civico - Di Cristina - Benfratelli Hospital, Gastroenterology and Endoscopy Unit, Palermo, Italy
,
G Russo
1   ARNAS Civico - Di Cristina - Benfratelli Hospital, Gastroenterology and Endoscopy Unit, Palermo, Italy
,
RD Mitri
1   ARNAS Civico - Di Cristina - Benfratelli Hospital, Gastroenterology and Endoscopy Unit, Palermo, Italy
› Author Affiliations
Further Information

Publication History

Publication Date:
23 April 2020 (online)

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Aims Endoscopic Sphincterotomy (EST) may not be effective for treating “difficult” common bile duct (CBD) stones or cases of complex bile duct access. Performing Dilation-Assisted Stone Extraction (DASE) after EST enhances technical success in stones extraction.

This study was designed to evaluate efficacy and safety of DASE associated to EST in “naïve” papilla and DASE in patients previously treated with EST.

Methods From January 2014 to September 2019 we collected data on 87 patients treated with DASE in our referral center. Technical success was obtained when the balloon was placed through the papilla and inflated until final diameter for an adequate time (>30 seconds) and stones were completely removed.

Results Forty-two males (48.3%) and 45 females (51.7%) were enrolled. Mean age was 72,5±12,1 years. Fifty-four patients (62.1%) were “naïve”, while 33 (37.9%) previously underwent EST.

Indications to DASE were: difficult CBD stones in 53 cases (60.9%), periampullary diverticulum in 15 (17.2%), difficult CBD cannulation in 11 (12.7%), altered anatomy in 5 (5.8%), others in 3 (3.4%). Technical success was achieved in 84 patients (96.6%).

Complications occurred in 21 cases (24.1%): 12/21 (57.1%) were intraprocedural, 7/21 (33.3%) were early (< 24h) and 2/21 (9.6%) were tardive (>24h). Complications were: 14 bleedings (66.7%), 6 post-ERCP pancreatitis (28.5%), 1 leak (4.8%). The leakage was immediately treated positioning metallic covered biliary stent. All the post-ERCP pancreatitis were clinically managed. Among the bleedings, in 7 cases (50.0%) no intervention was required; 6 cases (42.9%) were endoscopically managed; only 1 patient (7.1%) underwent interventional radiology.At univariable analysis, only previous EST was related to higher risk of complications (p=0.01).

Conclusions DASE associated to EST could be considered an alternative, safe and valid technique in difficult cases of biliary stones, in which EST alone would not be effective. Complication rate was quite low and corresponds to that previously reported in literature.