Background: The utility and safety of endoscopic papillary balloon dilation (EPBD) for bile duct stone removal using large diameter balloons after biliary sphincterotomy (BES) is currently not well established. Aims: To evaluate the efficacy and complications of large diameter EPBD for bile duct stone removal. Methods: Patients who underwent removal of common bile duct stones using large diameter dilating balloons (≥12 mm) were identified by query of the prospectively recorded endoscopic databases and medical records at 5 referral ERCP centers. Clinical parameters, endoscopic data, outcomes were collected and analyzed. Results: Ninety three patients, (mean age 71 ± 16 years with 53 (57%) females) who underwent 98 large-diameter EPBD procedures performed at discretion of endoscopists were identified. Nine patients (9%) had prior history of acute pancreatitis. ERCP findings, interventions, success and complications are shown on the table. BES alone for stone removal was judged inadequate or unsafe in 12 patients with smaller stones (<10 mm)due to altered anatomy (Billroth II, periampullary diverticulum), coagulopathy, and associated distal bile duct stricture. Summary: EBPD using a large diameter balloon in conjunction with BES for bile duct stones removal is effective and relatively safe. Conclusion: 1. When standard BES for stone extraction is inadequate, supplemental EPBD may be a reasonable alternative to facilitate removal of stones. 2. Larger series are needed to fully define efficacy and safety. Tabled 1Summary of 98 procedures in 93 patients undergoing large diameter EPBD Number of stones, n (%) —1-2 stones 39 (40) —≥3 stones 59 (60) Largest stone diameter, mm, median (range) 13 (5-30) Largest bile duct diameter, mm, median (range) 15 (8-30) Diameter of balloon dilation, mm, median (range) 13 (12-18) Periampullary diverticulum, n (%) 34 (37) Procedure types; n (%) —Only endoscopic papillary balloon dilation (EPBD) 2 (2) —Endoscopic sphincterotomy followed by EPBD/same session 53 (54) —Endoscopic sphincterotomy followed by EPBD/different session 43 (44) Lithotripsy required, n (%) 26 (27) Complete stone removal in single session, n (%) 91 (93) Pancreatic stent placement 3 (3) Complications, n (%) 1 (1) —Bleeding, mild 1 (1) —Cholangitis, mild 1 (1) —Perforation, severe, requiring 2-month hospitalization, no surgery 1 (1) —Abdominal pain requiring 2-day hospitalization 1 (1) —Documented pancreatitis 0 —Total complications 4 (4) Open table in a new tab