Multicenter retrospective and comparative study of 5-minute versus 15-second endoscopic papillary balloon dilation for removal of bile duct stones

BACKGROUND AND STUDY AIMS  Endoscopic papillary balloon dilation (EPBD) is a method of bile duct stone removal that has a better long-term outcome but a high risk of post-ERCP pancreatitis (PEP). Recent studies have suggested that 5-minute EPBD can reduce the incidence of PEP. This study aimed to examine the safety and effectiveness of longer duration EPBD compared with shorter duration EPBD (5 minutes vs. 15 seconds after disappearance of the waist of a dilation catheter). PATIENTS AND METHODS  Patients without a history of endoscopic sphincterotomy or EPBD who underwent EPBD to remove bile duct stones were selected retrospectively from five centers. The incidence of PEP, other early adverse events, and outcomes of EPBD were compared between the groups. A multivariable analysis of risk factors for PEP was performed. RESULTS  A total of 607 patients (157 and 450 in the 5-minute and 15-second EPBD groups, respectively) were included. There were no statistically significant differences between the groups in terms of the incidence of PEP (8.3 % and 8.9 % in the 5-minute and 15-second EPBD groups, respectively; P  = 0.871) and the incidence of overall early adverse events ( P  = 0.999). Although 5-minute EPBD elongated the procedure time (45 vs. 37 minutes, P  < 0.001), it increased the rate of complete stone removal during a single session ( P  < 0.001) and decreased the use of lithotripsy ( P  < 0.001). CONCLUSIONS  Compared with 15-second EPBD, 5-minute EPBD did not reduce the incidence of PEP.