Comparison of endoscopic papillary balloon dilatation with conventional endoscopic sphincterotomy for peripapillary choledochoduodenal fistula with bile duct stones

Background: Peripapillary choledochoduodenal fistula (PCDF) is occasionally detected during endoscopic retrograde cholangiopancreatography. This study was designed to compare perioperative outcomes of the peripapillary choledochoduodenal fistula with bile duct stones via endoscopic papillary balloon dilatation and conventional endoscopic sphincterotomy. Methods: We retrospectively reviewed 28 patients in whom a diagnosis was made with ERCP of benign peripapillary choledochoduodenal fistula between January 2009 and August 2014. Endoscopic sphincterotomy was performed in 10 patients and endoscopic papillary balloon dilation was performed in 18 patients. All clinical data were analyzed retrospectively. Results: The median operating time was significantly shorter in the EPBD group with a median of 19.78±4 mins versus 42.2±11.6 mins in the EST group (P<0.05). Postoperative complications occurred in five (50%) versus one (5.5%) patients in the EST and EPBD groups respectively. There were significant differences in postoperative complication rates. The rates of post-ERCP pancreatitis and perforation were not significantly different between the EPBD and EST groups [1/10 (10%) vs 2/18 (11%), P=0.7; 0% vs 0%; respectively]. There were 2 (20%) bleeding cases in EST group, and no bleeding cases in EPBD group.Conclusion: EPBD appear to be safe and effective modalities for common bile duct stone removal in patients with PCDF.