Retained bile duct stones in a patient with Billroth II gastrectomy: extracorporeal shock wave lithotripsy and papillary dilatation via T tube.

Discussant's Comment: Preventing Acute Pancreatitis Induced by Endoscopic Papillary Balloon Dilatation

“…9 However, some balloon dilatations of the papilla of Vater, via the transcutaneous route, were reported to be without complications when this method was combined with extracorporeal shock-wave lithotripsy. 10,11 Since a report of increased satisfactory results by MacMathuna 12 in 1995, an increasing number of reports on this issue have been published by many researchers. [13][14][15][16][17][18] Presently, the accepted indications for EPBD are considered to be: (i) patients with coagulopathy; (ii) patients who have undergone Billroth II reconstruction following gastrectomy; and (iii) patients who have a pacemaker.…”

Moderator's Comment: Endoscopic Balloon Dilatation of the Duodenal Papilla: Is it a Safe and Effective Treatment for Bile Duct Stones?

“…Contrary to expectations that it would be less invasive than EST, EPBD resulted in a high frequency of acute pancreatitis as a complication, and some endoscopists were disappointed (as reported by Kozarek) 9 . However, some balloon dilatations of the papilla of Vater, via the transcutaneous route, were reported to be without complications when this method was combined with extracorporeal shock‐wave lithotripsy 10,11 …”