Published online Feb 16, 2015. doi: 10.4253/wjge.v7.i2.77
Peer-review started: September 20, 2014
First decision: October 14, 2014
Revised: October 30, 2014
Accepted: November 17, 2014
Article in press: November 19, 2014
Published online: February 16, 2015
Although endoscopic sphincterotomy (EST) is still considered as a gold standard treatment for common bile duct (CBD) stones in western guideline, endoscopic papillary balloon dilation (EPBD) is commonly used by the endoscopists in Asia as the first-line treatment for CBD stones. Besides the advantages of a technical easy procedure, endoscopic papillary large balloon dilation (EPLBD) can facilitate the removal of large CBD stones. The indication of EPBD is now extended from removal of the small stones by using traditional balloon, to removal of large stones and avoidance of lithotripsy by using large balloon alone or after EST. According to the reports of antegrade papillary balloon dilatation, balloon dilation itself is not the cause of pancreatitis. On the contrary, adequate dilation of papillary orifice can reduce the trauma to the papilla and pancreas by the basket or lithotripter during the procedure of stone extraction. EPLBD alone is as effective as EPLBD with limited EST. Longer ballooning time may be beneficial in EPLBD alone to achieve adequate loosening of papillary orifice. The longer ballooning time does not increase the risk of pancreatitis but may reduce the bleeding episodes in patients with coagulopathy. Slowly inflation of the balloon, but not exceed the diameter of bile duct and tolerance of the patients are important to prevent the complication of perforation. EPBLD alone or with EST are not the sphincter preserved procedures, regular follow up is necessary for early detection and management of CBD stones recurrence.
Core tip: Indication of endoscopic papillary balloon dilation is now extended from removal of small common bile duct stones to large or difficult stones by using large balloon. Balloon dilation itself is not the cause of pancreatitis. Avoidance of unnecessary pancreatic contrast injection, use the suitable balloon and pressure, slowly balloon inflation and adequate ballooning time to achieve a widely opened papillary orifice are the important steps to perform a safe endoscopic papillary large balloon dilation and successful clearance of bile duct.