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Endoscopic balloon dilatation for removal of bile duct stones

INTRODUCTION

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 "Overview of indications for and complications of ERCP and endoscopic biliary sphincterotomy" and "Standard biliary sphincterotomy technique: The cutting edge".)

RATIONALE

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 [1].

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 [2]. 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].

             

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Literature review current through: Jun 2014. | This topic last updated: Dec 7, 2012.
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References
Top
  1. Bergman JJ, Rauws EA, Fockens P, et al. Randomised trial of endoscopic balloon dilation versus endoscopic sphincterotomy for removal of bileduct stones. Lancet 1997; 349:1124.
  2. Minami A, Nakatsu T, Uchida N, et al. Papillary dilation vs sphincterotomy in endoscopic removal of bile duct stones. A randomized trial with manometric function. Dig Dis Sci 1995; 40:2550.
  3. Bergman JJ, van Berkel AM, Groen AK, et al. Biliary manometry, bacterial characteristics, bile composition, and histologic changes fifteen to seventeen years after endoscopic sphincterotomy. Gastrointest Endosc 1997; 45:400.
  4. Bergman JJ, van der Mey S, Rauws EA, et al. Long-term follow-up after endoscopic sphincterotomy for bile duct stones in patients younger than 60 years of age. Gastrointest Endosc 1996; 44:643.
  5. Bergman JJ, Tytgat GN, Huibregtse K. Endoscopic dilatation of the biliary sphincter for removal of bile duct stones: an overview of current indications and limitations. Scand J Gastroenterol Suppl 1998; 225:59.
  6. Nelson DB, Freeman ML. Major hemorrhage from endoscopic sphincterotomy: risk factor analysis. J Clin Gastroenterol 1994; 19:283.
  7. Disario JA, Freeman ML, Bjorkman DJ, et al. Endoscopic balloon dilation compared with sphincterotomy for extraction of bile duct stones. Gastroenterology 2004; 127:1291.
  8. Komatsu Y, Kawabe T, Toda N, et al. Endoscopic papillary balloon dilation for the management of common bile duct stones: experience of 226 cases. Endoscopy 1998; 30:12.
  9. Mathuna PM, White P, Clarke E, et al. Endoscopic balloon sphincteroplasty (papillary dilation) for bile duct stones: efficacy, safety, and follow-up in 100 patients. Gastrointest Endosc 1995; 42:468.
  10. Bergman JJ, Huibregtse K. What is the current status of endoscopic balloon dilation for stone removal? Endoscopy 1998; 30:43.
  11. Bergman JJ, van Berkel AM, Bruno MJ, et al. A randomized trial of endoscopic balloon dilation and endoscopic sphincterotomy for removal of bile duct stones in patients with a prior Billroth II gastrectomy. Gastrointest Endosc 2001; 53:19.
  12. Ersoz G, Tekesin O, Ozutemiz AO, Gunsar F. Biliary sphincterotomy plus dilation with a large balloon for bile duct stones that are difficult to extract. Gastrointest Endosc 2003; 57:156.
  13. Heo JH, Kang DH, Jung HJ, et al. Endoscopic sphincterotomy plus large-balloon dilation versus endoscopic sphincterotomy for removal of bile-duct stones. Gastrointest Endosc 2007; 66:720.
  14. Bergman JJ, Huibregtse K. Endoscopic balloon dilatation of the biliary sphincter for removal of bile duct stones: Description of the endoscopic technique and review of the literature. Acta Endoscopica 1997; 27:405.
  15. Staritz M, Ewe K, Meyer zum Büschenfelde KH. Endoscopic papillary dilatation, a possible alternative to endoscopic papillotomy. Lancet 1982; 1:1306.
  16. Berkman WA, Bishop AF, Palagallo GL, Cashman MD. Transhepatic balloon dilation of the distal common bile duct and ampulla of Vater for removal of calculi. Radiology 1988; 167:453.
  17. Attam R, Freeman ML. Endoscopic papillary large balloon dilation for large common bile duct stones. J Hepatobiliary Pancreat Surg 2009; 16:618.
  18. Attasaranya S, Cheon YK, Vittal H, et al. Large-diameter biliary orifice balloon dilation to aid in endoscopic bile duct stone removal: a multicenter series. Gastrointest Endosc 2008; 67:1046.
  19. Itoi T, Itokawa F, Sofuni A, et al. Endoscopic sphincterotomy combined with large balloon dilation can reduce the procedure time and fluoroscopy time for removal of large bile duct stones. Am J Gastroenterol 2009; 104:560.
  20. Bergman JJ, Huibregtse K. Endoscopic Sphincterotomy and Stone Extraction. Semin Laparosc Surg 1995; 2:140.
  21. Freeman ML. Complications of endoscopic biliary sphincterotomy: a review. Endoscopy 1997; 29:288.
  22. Prat F, Fritsch J, Choury AD, et al. Endoscopic sphincteroclasy: a useful therapeutic tool for biliary endoscopy in Billroth II gastrectomy patients. Endoscopy 1997; 29:79.
  23. Fujita N, Maguchi H, Komatsu Y, et al. Endoscopic sphincterotomy and endoscopic papillary balloon dilatation for bile duct stones: A prospective randomized controlled multicenter trial. Gastrointest Endosc 2003; 57:151.
  24. Weinberg BM, Shindy W, Lo S. Endoscopic balloon sphincter dilation (sphincteroplasty) versus sphincterotomy for common bile duct stones. Cochrane Database Syst Rev 2006; :CD004890.
  25. Arnold JC, Benz C, Martin WR, et al. Endoscopic papillary balloon dilation vs. sphincterotomy for removal of common bile duct stones: a prospective randomized pilot study. Endoscopy 2001; 33:563.
  26. Vlavianos P, Chopra K, Mandalia S, et al. Endoscopic balloon dilatation versus endoscopic sphincterotomy for the removal of bile duct stones: a prospective randomised trial. Gut 2003; 52:1165.
  27. Ochi Y, Mukawa K, Kiyosawa K, Akamatsu T. Comparing the treatment outcomes of endoscopic papillary dilation and endoscopic sphincterotomy for removal of bile duct stones. J Gastroenterol Hepatol 1999; 14:90.
  28. Yasuda I, Tomita E, Enya M, et al. Can endoscopic papillary balloon dilation really preserve sphincter of Oddi function? Gut 2001; 49:686.
  29. Baron TH, Harewood GC. Endoscopic balloon dilation of the biliary sphincter compared to endoscopic biliary sphincterotomy for removal of common bile duct stones during ERCP: a metaanalysis of randomized, controlled trials. Am J Gastroenterol 2004; 99:1455.
  30. Tsujino T, Kawabe T, Komatsu Y, et al. Endoscopic papillary balloon dilation for bile duct stone: immediate and long-term outcomes in 1000 patients. Clin Gastroenterol Hepatol 2007; 5:130.
  31. Mac Mathuna P, Siegenberg D, Gibbons D, et al. The acute and long-term effect of balloon sphincteroplasty on papillary structure in pigs. Gastrointest Endosc 1996; 44:650.
  32. Cairns SR. Endoscopic balloon sphincteroplasty: use in a patient with a Billroth II gastrectomy. Endoscopy 1996; 28:790.
  33. Dickey W, Jacob S, Porter KG. Balloon dilation of the papilla via a forward-viewing endoscope: an aid to therapeutic endoscopic retrograde cholangiopancreatography in patients with Billroth-II gastrectomy. Endoscopy 1996; 28:531.