Abstract:Objective To compare the clinical efficiency of endoscopic sphincterotomy (EST) and limited endoscopic sphincterotomy plus endoscopic papillary balloon dilation (ESBD) in the treatment of giant choledocholithiasis. Methods All the 172 patients with choledocholithiasis larger than 15 mm from January 2012 to June 2013 were divided into EST group and ESBD group randomly (n=86, each). The stone-free rate, time of endoscopic lithotripsy, rate of mechanical lithotripsy and postoperative complications were compared between two groups. Results Between EST group and ESBD group, there were no significant differences in total stone-free rate(88.4% vs 86.0%, P=0.648) and first-time stone-free rate (81.4% vs 79.1%, P=0.702). There was no significant difference in operation time between EST group and ESBD group [(34.0±11.0) min vs (41.0±14.0) min, P=0.120]. The intra-operative mechanical lithotripsy rate in EST group was significant higher than that in ESBD group [45.1% (46/102) vs 30.7% (32/104), P=0.034]. There was no significant difference between EST group and ESBD group in the total postoperative complication occurrence rate [11.8%(12/102) vs 8.7%(9/104), P=0.461]. There were no significant differences in beleeding rate(P=0.205), hyperamylasemia rate (P=0.782) and acute pancreatitis rate (P=0.627). Conclusions ESBD is a safe and effective endoscopic treatment of giant choledocholithiasis, which could reduce the rate of mechanical lithotripsy. And the stone-free rate and operation time of ESBD are similar to those of EST.