17 - Balloon dilation of the native and postsphincterotomy papilla

Abstract

Endoscopic papillary balloon dilation (EPBD) and endoscopic papillary large-balloon dilation (EPLBD) in patients with native and postsphincterotomy papilla have been performed all around the world over several decades for the treatment of common bile duct (CBD) stones. EPBD using a small dilation balloon catheter can preserve sphincter of Oddi function and reduce the recurrence rate of bile duct stones compared with endoscopic sphincterotomy (EST). Because the risk of bleeding is low after EPBD, it is appropriate for patients with coagulopathy, hepatic cirrhosis, end-stage renal disease, and surgically altered anatomy, such as Billroth II gastrectomy and periampullary diverticulum. However, the risk of postprocedure pancreatitis (PEP) is higher after EPBD compared with EST. EPLBD using a large-balloon catheter (12 mm or more of diameter) is now being widely used to manage CBD stones larger than 10 mm in diameter. The advantages of EPLBD are reduced need for mechanical lithotripsy, along with decreased procedure time and radiation exposure time, irrespective of the presence of previous EST. EPLBD also requires fewer endoscopic retrograde cholangiopancreatography (ERCP) sessions, and it is more cost-effective. The incidence of PEP is lower in EPLBD compared with EST. If EPBD and EPLBD are done under proper guidelines for safe procedures, these procedures would prove to be safe and effective methods and may be good alternatives to EST for removing CBD stones.