Endoscopic Papillary Balloon Dilation for Removal of Choledocholithiasis: Indications, Advantages, Complications, and Long-Term Follow-Up Results

Abstract

Endoscopic papillary balloon dilation (EPBD) is an alternative method of endoscopic sphincterotomy (EST). Although concerns regarding post-procedure pancreatitis have been expressed, EPBD has come to be recognized as an effective and safe method for stone removal in specific cases. To analyze the proper indications, ideal methods, complications, and long-term follow-up results for EPBD, we reviewed articles about EPBD located through a search of the PubMed data base. We analyzed the ballooning methods, indications, results and complications of EPBD among the articles found and compared the results with those of EST. We considered the authors' own clinical experience and knowledge in developing recommendations for EPBD. EPBD showed similar effi cacy and safety for the removal of choledocholithiasis to that of EST. Although large or multiple stones were diffi cult to remove by EPBD, it was safer and easier to apply in patients with coagulopathy or abnormal anatomy. To prevent severe pancreatitis, excessive ballooning and impractical cannulation should be avoided, and precut sphincterotomy or adjuvant prophylaxis should be considered. Due to its preservation of the sphincter of Oddi, EPBD is expected to have fewer long-term complications, such as stone recurrence, cholangitis and cholecystitis. In conclusion, EPBD appears to be safe and effective for the treatment of choledocholithiasis with proper selection of ballooning methods and patients. (Gut Liver 2011;5:1-14)

Endoscopic Papillary Balloon Dilation for Removal of Bile Duct Stones

“…[1][2][3][4][5][6][7][8][9]11,12,15 EPBD and subsequent stone removal generally cleared the bile duct in 79% to 100% of patients in published studies. 1,3,4,[7][8][9][10][11] Our complete bile duct clearance rate was 91.6% (273/298).…”

“…It has gained popularity outside the United States 4 and, since 1983, it has been a safe and effective alternative to EST for removing CBD stones. [3][4][5][6] Although a high incidence of acute pancreatitis (4.3% to 19.8%) after this procedure has been reported in most published studies. [1][2][3][4][5][6][7][8][9][10] This technique was further reevaluated and reported that the pancreatitis complication rates of EPBD were similar to those of EST.…”

Small sphincterotomy combined with endoscopic papillary large balloon dilationvssphincterotomy alone for removal of common bile duct stones

“…First, EPBD results in less trauma to the ampullary sphincter. Second, EPBD might preserve the function of the biliary sphincter [2] , reducing late complications such as the recurrence of biliary stones [23,24] . Third, EPBD has the advantage of less bleeding and is safer for patients with bleeding tendency.…”

“…The demographic characteristics of the 153 patients cedure-related death (0.4%) [2] . EPBD has become an alternative to EST for the treatment of CBD stones.…”

“…Endoscopic papillary balloon dilation (EPBD) of the biliary sphincter was introduced as an alternative to EST, especially for patients with small or moderate CBD stones [2] . By using the wire-guided method, EPBD could be easily performed.…”