18 - Balloon Dilation of the Native and Postsphincterotomy Papilla

Abstract

Recent studies have shown that endoscopic sphincterotomy (EST) followed by large balloon dilation or large balloon dilation only for the removal of common bile duct (CBD) stones has good efficacy and acceptable adverse event rates. Theoretically, endoscopic papillary large-balloon dilation (EPLBD) without EST is easier to manipulate than the combined method and is also more suitable for patients with concomitant large stones and bleeding tendency. A retrospective cohort study that compared stone clearance between EPLBD without and with EST showed similar outcomes in overall successful stone removal (96.8% vs 95.7%; p = .738) and complete stone removal without endoscopic mechanical lithotripsy (80.6% vs 73.9%; p = .360). In a systematic review of 32 EPLBD studies, the initial success rate of EPLBD without EST was significantly lower than that of EPLBD with EST (76.2% vs 84.0%; p < .001). Although the type and the long-term adverse event rate after EST plus EPLBD is currently unknown, it is unlikely to be much different from that of EST or endoscopic papillary balloon dilation alone. EPLBD without EST may be a good alternative for the treatment of large bile duct stones, and sphincterotomy may not necessarily be a prerequisite for EPLBD in the treatment of such calculi. In patients with surgically altered anatomy, periampullary diverticulum, and previous EST, EPLBD without EST may be an effective and safe procedure to remove bile duct stones. However, definition of its exact role will require additional clinical experience and investigation.