Yonsei Med J.  2006 Dec;47(6):805-810. 10.3349/ymj.2006.47.6.805.

Endoscopic Papillary Balloon Dilation with Large Balloon after Limited Sphincterotomy for Retrieval of Choledocholithiasis

• Bang S
• Kim MH
• Park JY
• Park SW
• Song SY
• Chung JB

• KMID: 1777169
• DOI: http://doi.org/10.3349/ymj.2006.47.6.805

Abstract

Endoscopic papillary balloon dilation (EBD) for choledocholithiasis is known to be comparable to endoscopic sphincterotomy (EST) especially in cases of small stones. With larger stones, EBD with conventional balloon, which have a diameter of 6-8 mm, was reported as less effective for extraction of stones. We evaluated the efficacy and complications of EBD with large balloons (10-15 mm) after limited EST for retrieval of choledocholithiasis. From February 2005, we have performed EBD with limited EST for retrieval of common bile duct (CBD) stones. The patients who admitted with hyperamylasemia and gallstone pancreatitis were excluded. In cases without CBD dilation, EPBD with 12 mm for 40 seconds was performed. And in cases with CBD dilation, we dilated the sphincters with 15 mm sized balloon for 40 seconds. Total 22 patients (11 of male) were performed EBD with limited EST for retrieval of CBD stones. The median diameter of the stones was 10 mm (5-25 mm). Ten cases had multiple stones and 6 cases periampullary diverticuli. Successful stone removal in the initial session of ERCP with EBD was accomplished in 16 patients (72.7%). And complete retrieval of bile duct stones was achieved in all patients with repeated ERCP. In the aspect of complications, any episodes of perforation, bleeding was not developed. Only one case of mild grade of post-procedural pancreatitis was noted. However, post-procedural hyperamylasemia was developed in 16 cases (68.2%). EBD with larger balloon seems to be a feasible and safe alternative technique for conventional EST in CBD stone extraction.

Keyword

Choledocholithiasis; endoscopic retrograde pancreaticocholangiography; endoscopic papillary balloon dilation; endoscopic sphincterotomy

MeSH Terms

Treatment Outcome
*Sphincterotomy, Endoscopic/adverse effects
Male
Humans
Female
Choledocholithiasis/surgery/*therapy
*Balloon Dilatation/adverse effects
Aged

Figure

• 

  Fig. 1 Endoscopic papillary balloon dilation with limited endoscopic sphincterotomy. The endoscopic retrograde cholangiography (ERC) showed two free-floating stones, one of which was measured at 15 mm diameter, (A). A pull-type sphincterotome was inserted into the major papilla, located in the lower margin of the perivater diverticulum, (B). After limited EST, EBD with a balloon catheter of 15 mm diameter was performed, (C). The ERC showed the inflated balloon and its waist by the biliary sphincter had disappeared, black arrow, (D). With a Dormia basket, two stones were retrieved through the dilated orifice of major papilla, (E). ERC after complete stone retrieval revealed no residual filling defect in the bile duct, (F).

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