Combined sphincterotomy and sphincteroplasty versus sphincterotomy alone in the management of large CBD stones

  • Esraa Wefky egyptian
  • Osama Ebada Salem
  • Gamal Amin
  • Mohamed Shamseya
Keywords: Large bile duct stones, Endoscopic Sphincterotomy, Sphincteroplasty


Background: Endoscopic retrograde cholangiopancreatography (ERCP) with endoscopic sphincterotomy (ES) is the most widely used technique for treating choledocholithiasis. Challenges present with large stones hence additional techniques are needed. The aim of this study was to evaluate the efficacy and safety of combined sphincterotomy (EST) and sphincteroplasty (SP) versus sphincrotomy alone in the management of large common bile duct (CBD) stones.

Methods: A prospective study included fifty patients with choledocholithiasis subjected to ERCP. Twenty-five patients underwent ES with SP, and twenty five patients were subjected only to ES.

Results:  There was a significant statistical difference between the two groups (P=  0.002) regarding the rate of successful stone removal which was significantly higher in the EST with  SP group. (96.2% in the ES with SP group versus 62.9% in the ES group) but there was no statistical significant difference between the two groups regarding appearance of complications (p =0.460)  (19.2% in the ES with SP group versus 24.2% in the ES group).

Conclusion:  Endoscopic sphincterotomy with sphincteroplasty is effective and safe in the treatment of large CBD stones.