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World J Gastroenterol. Dec 7, 2013; 19(45): 8258-8268
Published online Dec 7, 2013. doi: 10.3748/wjg.v19.i45.8258
Endoscopic papillary balloon dilation: Revival of the old technique
Seung Uk Jeong, Sung-Hoon Moon, Myung-Hwan Kim
Seung Uk Jeong, Department of Internal Medicine, Jeju National University School of Medicine, Jeju 690-767, South Korea
Sung-Hoon Moon, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang 431-070, South Korea
Myung-Hwan Kim, Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 138-736, South Korea
Author contributions: Jeong SU and Kim MH designed the format; Jeong SU and Moon SH performed the literature search and wrote the paper; Kim MH reviewed the article and provided critical appraisal.
Correspondence to: Myung-Hwan Kim, MD, PhD, Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, 86 Asanbyeongwon-gil, Songpa-Gu, Seoul 138-736, South Korea.
Telephone: +82-2-30103183 Fax: +82-2-4760824
Received: August 26, 2013
Revised: September 18, 2013
Accepted: September 29, 2013
Published online: December 7, 2013

Radiologists first described the removal of bile duct stones using balloon dilation in the early 1980s. Recently, there has been renewed interest in endoscopic balloon dilation with a small balloon to avoid the complications of endoscopic sphincterotomy (EST) in young patients undergoing laparoscopic cholecystectomy. However, there is a disparity in using endoscopic balloon papillary dilation (EPBD) between the East and the West, depending on the origin of the studies. In the early 2000s, EST followed by endoscopic balloon dilation with a large balloon was introduced to treat large or difficult biliary stones. Endoscopic balloon dilation with a large balloon has generally been recognized as an effective and safe method, unlike EPBD. However, fatal complications have occurred in patients with endoscopic papillary large balloon dilation (EPLBD). The safety of endoscopic balloon dilation is still a debatable issue. Moreover, guidelines of indications and techniques have not been established in performing endoscopic balloon dilation with a small balloon or a large balloon. In this article, we discuss the issue of conventional and large balloon endoscopic dilation. We also suggest the indications and optimal techniques of EPBD and EPLBD.

Keywords: Endoscopic papillary balloon dilation, Endoscopic papillary large balloon dilation, Common bile duct stone, Endoscopic sphincterotomy, Mechanical lithotripsy

Core tip: Endoscopic papillary dilation with a dilating balloon is technically simple and effective. However, there is still debate regarding safety, and there is no guideline or consensus of detailed techniques. Because the procedure is performed to treat a common benign condition, it is important to ensure that there are no lethal procedure-related complications. It, however, can lead to potential morbidity and even death. As the foremost priority is patient safety, it should be performed with appropriate techniques in selected patients. Therefore, we suggest the optimal indications and tips for avoiding severe complications of endoscopic papillary balloon dilation with a small balloon or a large balloon.