Abstract
After selective biliary access following precut fistulotomy in difficult biliary cannulations (DBC), there are several methods of completely opening the remaining papillary roof for the removal of biliary stones. Additional sphincterotomy using papillotome or a needle-knife can be performed upwards or downwards from the fistula opening. However, it may be difficult to make adequate incisions due to the risk of complications, such as pancreatitis or perforation. We evaluated the efficacy of one-step trans-fistula balloon dilation following fistulotomy in DBC for the removal of biliary stones.
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