Endoscopic sphincterotomy with balloon dilation vs. monotherapy for choledocholithiasis in periampullary diverticulum: a randomized trial

Periampullary diverticulum (PAD) often increases the difficulty of ERCP operation, and there is no standardized treatment strategy. This study compared the efficacy of "small incision + large balloon dilation (EST + EPBD)" with traditional ERCP. 111 patients with PAD complicated with choledocholithiasis were randomly divided into experimental group (n = 55, EST < 5 mm + EPBD) and control group (n = 56, conventional EST/EPBD). The primary endpoints were one-time stone clearance and adverse event rate, while secondary endpoints included operative time and common bile duct pressure. One-time stone clearance rate: test group 98.1% vs. control group 87.5% (P = 0.029) • Mean operation time: 24 ± 9 min vs. 31 ± 11 min (P < 0.001) • CBD pressure 6 days after surgery: 11.5 ± 2.3 vs. 8.5 ± 1.6 cm H₂O (P < 0.001) • Incidence of postoperative pancreatitis: 3.6% vs. 10.7% (P = 0.206). EST + EPBD can significantly improve stone removal efficiency, shorten operation time, and may improve long-term prognosis by preserving Oddi sphincter function.