Same-Session Clearance of Small Common Bile Duct Stones After Sphincterotomy Alone or With Adjunctive Extraction: A Single-Center Observational Study
- 1Babol University of Medical Sciences
Abstract
BackgroundSmall common bile duct stones may pass after endoscopic sphincterotomy, but leaving the duct without attempting extraction also leaves clearance uncertain. We compared same-session stone clearance after sphincterotomy alone with clearance after sphincterotomy followed by balloon-based and/or basket extraction.
MethodsWe conducted a single-center observational study of 203 patients with common bile duct stones 5 mm or smaller who underwent therapeutic endoscopic retrograde cholangiopancreatography. The endoscopist chose the treatment during the procedure. Forty-seven patients underwent sphincterotomy alone, and 156 underwent sphincterotomy followed by balloon-based and/or basket extraction. The primary outcome was fluoroscopically confirmed clearance during the same procedure. Intraprocedural bleeding was a secondary outcome. We calculated unadjusted risk ratios and used Fishers exact test for sparse events.
ResultsThe mean age was 58.62 years (standard deviation 20.10), and 90 patients (44.3%) were men. Same-session clearance was documented in 21 of 47 patients (44.7%) after sphincterotomy alone and 130 of 156 (83.3%) after adjunctive extraction (risk ratio 1.87, 95% confidence interval 1.35 to 2.58; P < 0.001). A prominent ampulla was more common in the sphincterotomy-alone group (25.5% vs 10.9%; P = 0.012). Intraprocedural bleeding occurred in 2 patients after sphincterotomy alone and none after adjunctive extraction (4.3% vs 0%; Fishers exact P = 0.053).
ConclusionsAdjunctive extraction was associated with a higher rate of documented same-session clearance than sphincterotomy alone. Treatment was not randomized, the groups differed at baseline, and only two bleeding events occurred. These findings therefore do not prove that adjunctive extraction is causally superior or safer. Prospective studies using standardized techniques and follow-up are needed.
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BibTeX
@misc{chari2026samesession,
title = {{Same-Session Clearance of Small Common Bile Duct Stones After Sphincterotomy Alone or With Adjunctive Extraction: A Single-Center Observational Study}},
author = {F. Yadollahzadeh Chari and J. Shokri Shirvani and S. H. Abedi Valukalaei and A. Yadollahzadeh Chari},
howpublished = {medRxiv},
year = {2026},
month = sep,
doi = {10.64898/2026.09.17.26363343},
url = {https://www.medrxiv.org/content/10.64898/2026.09.17.26363343v1},
note = {CC BY-NC-ND},
}
RIS
TY - UNPB
TI - Same-Session Clearance of Small Common Bile Duct Stones After Sphincterotomy Alone or With Adjunctive Extraction: A Single-Center Observational Study
AU - F. Yadollahzadeh Chari
AU - J. Shokri Shirvani
AU - S. H. Abedi Valukalaei
AU - A. Yadollahzadeh Chari
PY - 2026
DA - 2026/09/17
PB - medRxiv
DO - 10.64898/2026.09.17.26363343
UR - https://www.medrxiv.org/content/10.64898/2026.09.17.26363343v1
AB - BackgroundSmall common bile duct stones may pass after endoscopic sphincterotomy, but leaving the duct without attempting extraction also leaves clearance uncertain. We compared same-session stone clearance after sphincterotomy alone with clearance after sphincterotomy followed by balloon-based and/or basket extraction. MethodsWe conducted a single-center observational study of 203 patients with common bile duct stones 5 mm or smaller who underwent therapeutic endoscopic retrograde cholangiopancreatography. The endoscopist chose the treatment during the procedure. Forty-seven patients underwent sphincterotomy alone, and 156 underwent sphincterotomy followed by balloon-based and/or basket extraction. The primary outcome was fluoroscopically confirmed clearance during the same procedure. Intraprocedural bleeding was a secondary outcome. We calculated unadjusted risk ratios and used Fishers exact test for sparse events. ResultsThe mean age was 58.62 years (standard deviation 20.10), and 90 patients (44.3%) were men. Same-session clearance was documented in 21 of 47 patients (44.7%) after sphincterotomy alone and 130 of 156 (83.3%) after adjunctive extraction (risk ratio 1.87, 95% confidence interval 1.35 to 2.58; P < 0.001). A prominent ampulla was more common in the sphincterotomy-alone group (25.5% vs 10.9%; P = 0.012). Intraprocedural bleeding occurred in 2 patients after sphincterotomy alone and none after adjunctive extraction (4.3% vs 0%; Fishers exact P = 0.053). ConclusionsAdjunctive extraction was associated with a higher rate of documented same-session clearance than sphincterotomy alone. Treatment was not randomized, the groups differed at baseline, and only two bleeding events occurred. These findings therefore do not prove that adjunctive extraction is causally superior or safer. Prospective studies using standardized techniques and follow-up are needed.
ER -