Endoscopic balloon dilatation (EBD) of the biliary sphincter can be a valuable adjunct to the therapeutic arsenal of the biliary endoscopist for removal of bile duct stones during endoscopic retrograde cholangiopancreatography (ERCP) in highly selected patients.
This topic will review endoscopic balloon dilation of the biliary sphincter. ERCP with endoscopic sphincterotomy is discussed separately. (See "Endoscopic retrograde cholangiopancreatography: Indications, patient preparation, and complications" and "Standard biliary sphincterotomy technique: The cutting edge".)
EBD permits effective stone removal with a success rate similar to that of endoscopic sphincterotomy (EST), the standard treatment for bile duct stones. In patients with small stones (≤10 mm), EBD permits successful stone extraction in virtually all cases without the need for an additional sphincterotomy or mechanical lithotripsy. In patients with more complicated stones (diameter >10 mm or number >3), the success rates of EBD and EST are comparable, but lithotripsy is required in about 50 percent of patients, and an additional sphincterotomy or repeat ERCP in 15 to 30 percent of patients .
EBD has a number of potential advantages compared with standard sphincterotomy.
- After EBD, the function of the biliary sphincter is preserved, whereas it is permanently lost after EST . This has the potential benefit of preventing the chronic reflux of gastroduodenal contents into the biliary system observed after EST. However, although patients who have undergone EST may have bacterial colonization and chronic inflammation of the biliary epithelium, its clinical significance is uncertain since long-term follow-up studies after EST have not shown a high rate of serious complications [3,4].
- Compared with EST, EBD reduces the risk of bleeding after the ERCP and is therefore especially suited for the treatment of patients with hemostatic disorders [1,5,6].