Is endoscopic papillary large balloon dilatation without endoscopic sphincterotomy effective?

Abstract

EST before sphincteroplasty may be unnecessary in EPLBD. Further investigations are needed to verify the relationship between the presence or absence of balloon waist disappearance.

Japan Gastroenterological Endoscopy Society guidelines for endoscopic papillary large balloon dilation

“…They found no significant difference in the incidence of procedural accidents (8.6%, 7.5%, 7.0%, P = 0.568) and the onset of pancreatitis (2.1%, 3.1%, 3.9%, P = 0.349) in 756 patients who underwent EPLBD with large EST, in 946 patients who underwent EPLBD with limited EST, and in 416 patients who underwent EPLBD without EST. Similar reports have been published . Thus, performing EST before EPLBD is considered to have a slight effect from the perspective of procedural adverse events.…”

“…Furthermore, in two RCTs of EPLBD with EST and EPLBD without EST, reports of both trials indicated no difference in the rate of stone removal or ML usage. It was concluded that EST was not necessary before EPLBD . However, according to the meta‐analysis conducted by Kim et al ., the stone removal rate in the first session was significantly higher with EST (with EST 84.0% vs. without EST 76.2%, P < 0.001), and the rate of ML usage was significantly lower with EST (with EST 14.1% vs. without EST 21.6%, P < 0.001).…”

“…It was concluded that EST was not necessary before EPLBD. 29,33 However, according to the meta-analysis conducted by Kim et al, 32 the stone removal rate in the first session was significantly higher with EST (with EST 84.0% vs. without EST 76.2%, P < 0.001), and the rate of ML usage was significantly lower with EST (with EST 14.1% vs. without EST 21.6%, P < 0.001). Thus, performing EPLBD with EST might help improve the initial stone removal rate and reduce the rate of ML usage.…”

“…Similar reports have been published. 33,34 Thus, performing EST before EPLBD is considered to have a slight effect from the perspective of procedural adverse events. However, attention should be drawn to the fact that these reports included patients with bile duct dilatation and large stones.…”

What Is the Value of the Learning Curve in Endoscopic Balloon Dilatation of the Major Papilla?

“…Results of the present study, with an 82.5% efficacy rate in the first session, 87% in the second EPLBD-EST, and an adverse event rate of 16%, are similar to previous studies published in the literature [ 11 , 15 , 22 – 26 ]. Results support EPLBD-EST as an efficient and relatively safe technique for those patients with difficult stones.…”