To compare dilated papillary sphincter via T-tube balloon catheter to extrude stones and calculus removal with choledochoscope.

Forty-one patients with residual common bile duct stones after common bile duct exploration with T-tube drainage were enrolled in the study from February 2008 to June 2014. Twenty patients were treated with balloon dilation of the papilla and the use of an occlusion balloon for clearance of bile duct calculi via T tube, and were allocated to balloon sphincteroplasty group. The other 21 patients, treated with choledochoscope through T tube sinus, were allocated to choledochoscope group. The size of common bile duct, retention time of T tube, the size and number of stones, operation time, clearance rate of bile duct stones, and postoperative complications between the two groups were compared.

The preoperative T tube indwelling time in balloon sphincteroplasty group was significantly shorter than that in choledochoscope group [(24.2±9.7) d vs (65.4±14.6) d, t=16.4, P<0.01]. The size of common bile duct and the diameter of T tube in balloon sphincteroplasty group were significantly shorter than those in choledochoscope group [(13±5) mm vs (19±7) mm, t=3.144, P<0.01; (5.3±0.7) mm vs (7.2±0.9) mm, t=7.152, P<0.01]. There was no significant difference between the two groups in terms of clearance rate of bile duct calculi, overall postoperative morbidity rate, postoperative WBC count, C-reactive protein concentration, stone recurrence rate and bile duct stricture rate throughout the follow-up period after complete clearance of bile duct.

Common bile duct stone clearance by dilation of the papilla and evacuation of the residual stones with an occlusion balloon via T tube is as safe and effective as stone extraction with choledochoscope through T tube sinus. The technique can shorten T tube retention time and is still available to slim common bile duct and T tube.