Endoscopy 2019; 51(04): S234
DOI: 10.1055/s-0039-1681871
ESGE Days 2019 ePosters
Friday, April 5, 2019 09:00 – 17:00: ERCP ePosters
Georg Thieme Verlag KG Stuttgart · New York

BALLOON SPHINCTEROPLASTY IS A SAFE AND RELIABLE METHOD TO ACHIEVE BILIARY CLEARANCE IN AN AT RISK CHOEDOCHOLITHIASIS COHORT

M Syafiq Ismail
1   Department of Gastroenterology, Tallaght University Hospital, Dublin, Ireland
2   Trinity Academic Gastroenterology Group, Trinity College Dublin, Dublin, Ireland
,
N O'Morain
1   Department of Gastroenterology, Tallaght University Hospital, Dublin, Ireland
,
B Ryan
1   Department of Gastroenterology, Tallaght University Hospital, Dublin, Ireland
,
D McNamara
1   Department of Gastroenterology, Tallaght University Hospital, Dublin, Ireland
2   Trinity Academic Gastroenterology Group, Trinity College Dublin, Dublin, Ireland
› Author Affiliations
Further Information

Publication History

Publication Date:
18 March 2019 (online)

Also available at
 
 

    Introduction:

    Endoscopic balloon sphincteroplasty (EBP) has been recommended by ESGE as an alternative to Endoscopic Sphincterotomy (ES) in patients with coagulopathy or alternated anatomy.

    Aim:

    To investigate the effectiveness of EBP versus ES in managing selected patients with choledocholithiasis at TUH.

    Method:

    Over one year, patients with untreated coagulopathy or abnormal anatomy, with choledocholithiasis were recruited. Indication, demographics, diagnosis, duct clearance rates, sedation and complications were recorded. EBP was performed with an 8 mm Hurricane Biliary Balloon for ≥4 minutes under direct and fluoroscopic control, with subsequent stone extraction using standard techniques. Outcomes were compared to age and sex matched ES choledocholithiasis patients.

    Results:

    Of 577 ERCP's, 19 EBPs were performed and compared to 57 matched ES cases. Mean age 62 (21 – 91), 29 (38%) males. Indications: gallstone pancreatitis 4 (5%), choledocholithiasis alone 72 (95%). Findings: Confirmed choledocholithiasis, 15/19 (79%) and 42/57 (74%), normal balloon trawl, 3/19 (16%) and 15/57 (26%) in EBP and ES groups respectively and 1/19 (5%) EPB stricture.

    While failure of duct clearance was less common in EBP patients (OR 0.65), the difference was not significant; 87% (13/15) EBP vs. 81% (34/42) ES, p = 0.47. Despite EBP patients being coagulopathic, ES intra-procedural bleeding rates were higher (OR 3.3), again non-significant; EBP 1/19 (5%) vs. ES 9/57 (67), p = 0.4. There were no significant post-procedure complications; procedure duration and mean sedation were comparable.

    Conclusion:

    EBP was not inferior to ES in selected patients with choledocholithiasis. A low bleeding rate despite coagulopathy, with effective duct clearance suggests EBP warrants further investigation.


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