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Dilation assisted stone extraction for complex biliary lithiasis:Technical aspects and practical principles

World Journal of Gastrointestinal Endoscopy 2021年第2期13卷 33-44页

作者： Giuseppe Grande Silvia Cocca Helga Bertani Angelo Caruso Flavia Pigo' Santi Mangiafico Salvatore Russo Marinella Lupo Graziella Masciangelo Paolo Cantu' Raffaele Manta Rita Conigliaro Gastroenterology and Digestive Endoscopy Unit Azienda Ospedaliero Universitaria di ModenaModena 41126Italy Gastroenterology and Endoscopy Unit Department of Pathophysiology and TransplantationFondazione IRCCS Ca’GrandaOspedale Maggiore Policlinico and Universitàdegli Studi di MilanoMilano 20122Italy Gastroenterology and Digestive Endoscopy Unit General Hospital of PerugiaPerugia 06129Italy

Common bile duct stones are frequently diagnosed worldwide and are one of the main indications for endoscopic retrograde *** sphincterotomy(EST)has been used for the removal of bile duct stones for the past 40 years,providing a wide opening to allow *** to 15%of patients present with complicated *** this context,additional therapeutic approaches have been proposed such as endoscopic mechanical lithotripsy,intraductal or extracorporeal lithotripsy,or endoscopic papillary large balloon dilation(EPLBD).EPLBD combined with EST was introduced in 2003 to facilitate the passage of large or multiple bile duct stones using a balloon greater than 12 mm in *** without EST was introduced as a simplified technique in ***-assisted stone extraction(DASE)is the combination of two techniques:EPLBD and sub-maximal *** studies have reported this technique as safe and effective in patients with large bile duct stones,without any increased risk of adverse events such as pancreatitis,bleeding,or ***,it is difficult to analyze the outcomes of DASE because there are no standard techniques and definitions between *** purpose of this paper is to provide technical guidance and specific information about the main issues regarding DASE,based on current literature and daily clinical experience in biliary referral centers.

关键词： Dilation-assisted stone extraction Endoscopic papillary large balloon dilation Macrolithiasis Difficult choledochiolithiasis stone treatment Common bile duct stones Endoscopic retrograde cholangiopancreatography

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