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  • Title: Endoscopic balloon sphincteroplasty for extraction of large radiolucent pancreatic duct stones (with videos).
    Author: Maydeo A, Bhandari S, Bapat M.
    Journal: Gastrointest Endosc; 2009 Oct; 70(4):798-802. PubMed ID: 19788986.
    Abstract:
    BACKGROUND: Although radiopaque pancreatic duct stones can be targeted by extracorporeal shock wave lithotripsy (ESWL) and extracted by ERCP, large and radiolucent stones remain a therapeutic challenge. OBJECTIVE: To evaluate the technical success and safety of endoscopic balloon sphincter dilation technique (sphincteroplasty) for extraction of large radiolucent pancreatic duct stones. DESIGN: Case series. SETTING: Tertiary referral center. PATIENTS: Four symptomatic patients with large (> or =1 cm) radiolucent stones occluding the main pancreatic duct that could not be retrieved by standard endoscopic maneuvers. INTERVENTIONS: Pancreatic sphincterotomy followed by balloon dilation of the pancreatic orifice to aid retrieval of large radiolucent stones occluding the main pancreatic duct. MAIN OUTCOME MEASUREMENTS: Technical success and safety of the balloon dilation (sphincteroplasty) technique. Technical success was defined as the ability to achieve pancreatic duct clearance in 1 endoscopic encounter. Complications were assessed according to consensus criteria. RESULTS: The procedure was technically successful in all 4 patients. Pancreatic duct clearance was achieved in all 4 patients in 1 endoscopy session with complete symptom relief at 12-month follow-up. Mild post-ERCP pancreatitis developed in 1 patient, and minor bleeding developed in another patient; both were managed conservatively. LIMITATION: Small number of patients. CONCLUSIONS: Endoscopic balloon dilation of the pancreatic orifice after sphincterotomy is a safe technique that facilitates the removal of large radiolucent stones from the main pancreatic duct in 1 endoscopic session. More studies with larger numbers of patients are required before this technique can be adopted routinely as a treatment alternative for patients with large radiolucent pancreatic duct stones.
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