Grande G, Cocca S, Bertani H, Caruso A, Pigo' F, Mangiafico S, Russo S, Lupo M, Masciangelo G, Cantu' P, Manta R, Conigliaro R. Dilation assisted stone extraction for complex biliary lithiasis: Technical aspects and practical principles. World J Gastrointest Endosc 2021; 13(2): 33-44 [PMID: 33623638 DOI: 10.4253/wjge.v13.i2.33]
Corresponding Author of This Article
Giuseppe Grande, MD, Staff Physician, Gastroenterology and Digestive Endoscopy Unit, Azienda Ospedaliero Universitaria di Modena, Via Pietro Giardini 1355, Modena 41126, Italy. grande.giuseppe@aou.mo.it
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Opinion Review
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Giuseppe Grande, Silvia Cocca, Helga Bertani, Angelo Caruso, Flavia Pigo', Santi Mangiafico, Salvatore Russo, Marinella Lupo, Graziella Masciangelo, Rita Conigliaro, Gastroenterology and Digestive Endoscopy Unit, Azienda Ospedaliero Universitaria di Modena, Modena 41126, Italy
Paolo Cantu', Gastroenterology and Endoscopy Unit, Department of Pathophysiology and Transplantation, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico and Università degli Studi di Milano, Milano 20122, Italy
Raffaele Manta, Gastroenterology and Digestive Endoscopy Unit, General Hospital of Perugia, Perugia 06129, Italy
Author contributions: Grande G and Conigliaro R conceived and designed the study; Grande G, Caruso A, Bertani H, Manta R, and Mangiafico S equally contributed to each topic of the project; Pigo F, Marocchi M, Cantù P, Russo S, Lupo M, and Masciangelo G contributed to the analytic tools and bibliography research; Grande G and Cocca S analyzed the data and wrote the manuscript; Caruso A and Mangiafico S revised the figures; All authors have read and approved the final manuscript.
Conflict-of-interest statement: All authors declare no conflict of interests.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Giuseppe Grande, MD, Staff Physician, Gastroenterology and Digestive Endoscopy Unit, Azienda Ospedaliero Universitaria di Modena, Via Pietro Giardini 1355, Modena 41126, Italy. grande.giuseppe@aou.mo.it
Received: September 21, 2020 Peer-review started: September 21, 2020 First decision: December 11, 2020 Revised: December 27, 2020 Accepted: January 22, 2021 Article in press: January 22, 2021 Published online: February 16, 2021
Abstract
Common bile duct stones are frequently diagnosed worldwide and are one of the main indications for endoscopic retrograde cholangio-pancreatography. Endoscopic sphincterotomy (EST) has been used for the removal of bile duct stones for the past 40 years, providing a wide opening to allow extraction. Up to 15% of patients present with complicated choledocholithiasis. In this context, additional therapeutic approaches have been proposed such as endoscopic mechanical lithotripsy, intraductal or extracorporeal lithotripsy, or endoscopic papillary large balloon dilation (EPLBD). EPLBD combined with EST was introduced in 2003 to facilitate the passage of large or multiple bile duct stones using a balloon greater than 12 mm in diameter. EPLBD without EST was introduced as a simplified technique in 2009. Dilation-assisted stone extraction (DASE) is the combination of two techniques: EPLBD and sub-maximal EST. Several studies have reported this technique as safe and effective in patients with large bile duct stones, without any increased risk of adverse events such as pancreatitis, bleeding, or perforation. Nevertheless, it is difficult to analyze the outcomes of DASE because there are no standard techniques and definitions between studies. The purpose of this paper is to provide technical guidance and specific information about the main issues regarding DASE, based on current literature and daily clinical experience in biliary referral centers.
Core Tip: This narrative and practical review has been written to clarify some issues and key points regarding the treatment of difficult common bile duct stone using dilation assisted stone extraction technique.
