Stent-guided sphincterotomy

Japan Gastroenterological Endoscopy Society guidelines for endoscopic papillary large balloon dilation

“…[71][72][73][74][75][76] This rates were better than the success rates for stone removal (81.3%-100%) using EST for similar patients with surgically altered anatomy. [77][78][79] In these EPLBD studies in patients with surgically altered anatomy, only mild pancreatitis and mild-to-moderate bleeding were noted without any perforation or serious adverse events. On the other hand, in EPLBD without EST, case reports of severe acute pancreatitis can be found.…”

“…Although based on case reports and case series, in patients with surgically altered anatomy such as Billroth II surgery and Roux‐en‐Y anastomosis, relatively high rates of complete stone clearance have been reported (96.7%–100%) . This rates were better than the success rates for stone removal (81.3%–100%) using EST for similar patients with surgically altered anatomy . In these EPLBD studies in patients with surgically altered anatomy, only mild pancreatitis and mild‐to‐moderate bleeding were noted without any perforation or serious adverse events.…”

International consensus guidelines for endoscopic papillary large-balloon dilation

“…Six case series of EPLBD with limited EST, mainly using a needle-knife or a rotatable papillotome in patients with a surgically altered anatomy such as Billroth II surgery and Roux-en-Y anastomosis, reported relatively high rates of complete stone clearance (96.7%-100%) 57-62 compared with 81.3% to 100% in other studies using adjusted EST techniques to suit the surgically altered anatomy. [63][64][65] In all of these EPLBD studies in patients with a surgically altered anatomy, only mild pancreatitis and mild to moderate bleeding were noted without any perforation or serious adverse events. Jang et al 66 reported complete CBD stone removal after EPLBD without EST in all Billroth II gastrectomy patients with large or difficult CBD stones without any serious adverse events.…”

Japan Gastroenterological Endoscopy Society guidelines for endoscopic sphincterotomy

“…106,107 It has been reported that regarding EST, because the papilla is approached from the anal side, cutting can be done using a pushtype sphincterotome or a specialized sphincterotome for patients with Billroth II reconstruction, [106][107][108][109][110][111] or the method in which a biliary guidewire or stent are placed and then cutting is done using a needle-knife. 90,112,113 In a randomized controlled trial of EST using a needleknife, the success rates for forward-viewing, and sideviewing were 80% (8/10) vs 83% (10/12) with no significant difference observed, and although there was no significant difference in adverse events associated with EST, adverse events associated with scope insertion were significantly more common in sideviewing (0% vs 18%, P < 0.05). 113 In a report of 713 patients from a high-volume institution, the papilla was reached in 86.7%, EST was done in 490 patients (84.5%), post-EST bleeding occurred in 11 patients (1%), and perforation occurred in three patients (0.3%).…”

“…In recent years, ERCP using a balloon‐enteroscope has been carried out mainly for difficult cases . It has been reported that regarding EST, because the papilla is approached from the anal side, cutting can be done using a push‐type sphincterotome or a specialized sphincterotome for patients with Billroth II reconstruction, or the method in which a biliary guidewire or stent are placed and then cutting is done using a needle‐knife . In a randomized controlled trial of EST using a needle‐knife, the success rates for forward‐viewing, and side‐viewing were 80% (8/10) vs 83% (10/12) with no significant difference observed, and although there was no significant difference in adverse events associated with EST, adverse events associated with scope insertion were significantly more common in side‐viewing (0% vs 18%, P < 0.05) .…”