Partial papillosphincterotomy with balloon dilatation in the treatment of choledocholytiasis in patients with parapapillary diverticulum

Results of treatment of 42 patients suffering from choledocholytiasis and parapapillary diverticle are compared, by which for treatment limited papillosfincterotomy supplemented with endoscopic balloon dilatation is performed with results of treatment of 56 patients with similar pathology, by which traditional endoscopic papillosfincterotomy was performed. Limited papillosphincterotomy with endoscopic balloon dilatation resulted in complete lithoextraction in 92.9% of cases as compared to 92.8% with endoscopic papillosphincterotomy only; an adequate drainage of extrahepatic bile ducts was achieved in 100% and 96.4%, respectively (p > 0.05). With endoscopic papillosphincterotomy, full removal of all concretions with a diameter of less than one centimeter was achieved without mechanical lithotripsy; for concretions from 1 to 1.5 cm in size the mechanical lithotripsy was necessary in 45.5% of cases. Limited papillosphincterotomy with endoscopic balloon dilatation allowed lithoextraction of concretions with a diameter of up to 1.5 cm without mechanical lithotripsy in all patients. The mechanical lithotripsy for concretions with a diameter above 1.5 cm was necessary in 60% of cases for both methods. In the treatment arm, two (4.8%) cases with complications were observed, while in the control arm there were 13 (23.2%) cases (p = 0.012). Acute pancreatitis was the only postoperative complication for which significant difference was observed (р = 0.043). In addition, after endoscopic papillosphincterotomy the incidence of bleeding from the suture line was 3.6% and the incidence of perforation of diverticula was 3.6%; this required an open surgery. The above mentioned demonstrates the advantages of limited papillosphincterotomy with endoscopic balloon dilatation over endoscopic papillosphincterotomy to resolve choledocholytiasis in the presence of parapapillary diverticulum.