Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2012 May 16;4(5):180-4.
doi: 10.4253/wjge.v4.i5.180.

Endoscopic papillary large balloon dilation after limited sphincterotomy for difficult biliary stones

Ana Rebelo  1 , Pedro Moutinho Ribeiro, António Pinto Correia, José Cotter
Affiliations

Endoscopic papillary large balloon dilation after limited sphincterotomy for difficult biliary stones

Ana Rebelo et al. World J Gastrointest Endosc. .

Abstract

Aim: To assess the efficacy and safety of endoscopic papillary large balloon dilation after biliary sphincterotomy for difficult bile duct stones retrieval.

Methods: Retrospective review of consecutive patients submitted to the technique during 18 mo. The main outcomes considered were: efficacy of the procedure (complete stone clearance; number of sessions; need of lithotripsy) and complications.

Results: A total of 30 patients with a mean age of 68 ± 10 years, 23 female (77%) and 7 male (23%) were enrolled. In 10 patients, a single stone was found in the common bile duct (33%) and in 20 patients multiple stones (67%) were found. The median diameter of the stones was 17 mm (12-30 mm). Dilations were performed with progressive diameter Through-The-Scope balloons (up to 12, 15) or 18 mm. Complete retrieval of stones was achieved in a single session in 25 patients (84%) and in two sessions in 4 patients (13%). Failure occurred in 1 case (6%). Mechanical lithotripsy was performed in 6 cases (20%). No severe complications occurred. One patient (3%) had mild-grade post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis.

Conclusion: Endoscopic balloon dilatation with a large balloon after endoscopic sphincterotomy is a safe and effective technique that could be considered an alternative choice in therapeutic ERCP.

Keywords: Balloon dilation; Cholelithiasis; Endoscopic retrograde cholangiopancreatography; Lithotripsy; Sphincterotomy.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Endoscopic view of papillary large balloon (18 mm) dilation after limited sphincterotomy in a patient with a single large bile duct stone (30 mm, egg shaped).
Figure 2
Figure 2
Fluoroscopy sequence showing a dilated common bile duct with a large single stone inside. Balloon inflation until the notch on the waist disappears; clearance of the common bile duct with a Dormia basket.
See this image and copyright information in PMC

References

    1. Classen M, Demling L. [Endoscopic sphincterotomy of the papilla of vater and extraction of stones from the choledochal duct (author's transl)] Dtsch Med Wochenschr. 1974;99:496–497. - PubMed
    1. Kawai K, Akasaka Y, Murakami K, Tada M, Koli Y. Endoscopic sphincterotomy of the ampulla of Vater. Gastrointest Endosc. 1974;20:148–151. - PubMed
    1. Freeman ML, Nelson DB, Sherman S, Haber GB, Herman ME, Dorsher PJ, Moore JP, Fennerty MB, Ryan ME, Shaw MJ, et al. Complications of endoscopic biliary sphincterotomy. N Engl J Med. 1996;335:909–918. - PubMed
    1. Staritz M, Ewe K, Meyer zum Büschenfelde KH. Endoscopic papillary dilation (EPD) for the treatment of common bile duct stones and papillary stenosis. Endoscopy. 1983;15 Suppl 1:197–198. - PubMed
    1. Bergman JJ, Rauws EA, Fockens P, van Berkel AM, Bossuyt PM, Tijssen JG, Tytgat GN, Huibregtse K. Randomised trial of endoscopic balloon dilation versus endoscopic sphincterotomy for removal of bileduct stones. Lancet. 1997;349:1124–1129. - PubMed