Long‐Term Outcomes After Endoscopic Papillary Large Balloon Dilation With Endoscopic Sphincterotomy for Difficult Biliary Stones: A Multicenter Retrospective Longitudinal Study

INTRODUCTION: Endoscopic papillary large balloon dilation (EPLBD) is currently considered the first-line treatment for difficult biliary stones (DBS). However, EPLBD alters the sphincter of Oddi's function, potentially exposing patients to cholangitis. To date, few data are available on the long-term consequences of EPLBD. AIMS AND METHODS: The aim of this study is to explore the long-term complications of EPLBD with endoscopic sphincterotomy (ES) in terms of cholangitis and biliary recurrence. Adult patients who underwent EPLBD with ES with complete bile duct clearance were included in the study. Primary outcome of the study was the rate of cholangitis; secondary outcome was biliary recurrence after EPLBD. RESULTS: 1221 patients with a median age of 77 years old (IQR 68-84) were included in the study. One hundred and forty-three patients (11.7%) experienced at least one episode of cholangitis with a cumulative 1-, 3-, and 5-year risk of cholangitis of 7.3%, 13.2%, and 15.3%, respectively. Cholangitis was caused by stones recurrence in 71.6% of cases, whereas alithiasic cholangitis was experienced in 22.9% of patients. The estimated 1-, 3-, and 5-year risk of biliary recurrence was 9.7%, 16.7%, and 21.8%, respectively. In multivariate cox regression analysis, ≥ 2 previous ERCPs before EPLBD were independently associated with increased risk of cholangitis and biliary recurrence. CONCLUSIONS: Cholangitis and biliary recurrence are not an infrequent complication after EPLBD. Biliary stone recurrence may be a consequence of SO dysfunction after EPLBD with ES; further comparative data are needed to evaluate whether EPLBD with ES is directly associated with long-term complications.

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Journal
Digestive Endoscopy
Published
2026-06-24
DOI
https://doi.org/10.1111/den.70204
Primary Topic
Gallbladder and Bile Duct Disorders
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article
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article

Long‐Term Outcomes After Endoscopic Papillary Large Balloon Dilation With Endoscopic Sphincterotomy for Difficult Biliary Stones: A Multicenter Retrospective Longitudinal Study

Mia Rainio, Claudio Zulli, Cecilia Binda, Stefano Mazza et al.
Digestive Endoscopy
Gallbladder and Bile Duct Disorders
article

Long‐Term Outcomes After Endoscopic Papillary Large Balloon Dilation With Endoscopic Sphincterotomy for Difficult Biliary Stones: A Multicenter Retrospective Longitudinal Study

Mia Rainio, Claudio Zulli, Cecilia Binda, Stefano Mazza, Vincenzo Occhipinti, Davide Scalvini, G. Del Vecchio Blanco, D. Berretti, L Kylänpää, Andrea Tenca, Giuseppe Vanella, Aurelio Mauro, Gianluca Franchellucci, Germana de Nucci, G. Marzocca, Andrea Lisotti, G. Fierro, Evgenija Lozova, Carlo Fabbri, E Forti, F Desideri, G Venezia, R Grassia, Ilaria Tarantino, Andrea Anderloni, Marco Spadaccini, Giovanni Aragona
article en

Abstract

INTRODUCTION: Endoscopic papillary large balloon dilation (EPLBD) is currently considered the first-line treatment for difficult biliary stones (DBS). However, EPLBD alters the sphincter of Oddi's function, potentially exposing patients to cholangitis. To date, few data are available on the long-term consequences of EPLBD. AIMS AND METHODS: The aim of this study is to explore the long-term complications of EPLBD with endoscopic sphincterotomy (ES) in terms of cholangitis and biliary recurrence. Adult patients who underwent EPLBD with ES with complete bile duct clearance were included in the study. Primary outcome of the study was the rate of cholangitis; secondary outcome was biliary recurrence after EPLBD. RESULTS: 1221 patients with a median age of 77 years old (IQR 68-84) were included in the study. One hundred and forty-three patients (11.7%) experienced at least one episode of cholangitis with a cumulative 1-, 3-, and 5-year risk of cholangitis of 7.3%, 13.2%, and 15.3%, respectively. Cholangitis was caused by stones recurrence in 71.6% of cases, whereas alithiasic cholangitis was experienced in 22.9% of patients. The estimated 1-, 3-, and 5-year risk of biliary recurrence was 9.7%, 16.7%, and 21.8%, respectively. In multivariate cox regression analysis, ≥ 2 previous ERCPs before EPLBD were independently associated with increased risk of cholangitis and biliary recurrence. CONCLUSIONS: Cholangitis and biliary recurrence are not an infrequent complication after EPLBD. Biliary stone recurrence may be a consequence of SO dysfunction after EPLBD with ES; further comparative data are needed to evaluate whether EPLBD with ES is directly associated with long-term complications.

Digestive EndoscopyVol. 38(7)
University of Rome Tor Vergata (IT), University of Helsinki (FI), University of Pavia (IT), Helsinki University Hospital (FI), Ospedale di Bolzano (IT), Azienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda (IT), Ospedale Papa Giovanni XXIII (IT), Ospedale Santa Maria della Misericordia di Udine (IT), Azienda Socio Sanitaria Territoriale Lariana (IT), Ospedali Riuniti San Giovanni di Dio e Ruggi d'Aragona (IT), Azienda Sanitaria Ospedaliera S.Croce e Carle Cuneo (IT), Guglielmo da Saliceto Hospital (IT), Istituto Oncologico Romagnolo (IT), Sacmi (Italy) (IT), Policlinico San Matteo Fondazione (IT), IRCCS Humanitas Research Hospital (IT), Pancreas Centre (Canada) (CA), Azienda Sanitaria Universitaria Integrata di Trieste (IT), Istituti Ospitalieri di Cremona (IT), Hospital District of Helsinki and Uusimaa (FI), Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione (IT)
Good health and well-being
Openalex Percentile: Top 7%
Gallbladder and Bile Duct Disorders
DOISourceOpenAlex
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