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World J Gastroenterol. Jun 28, 2014; 20(24): 7760-7766
Published online Jun 28, 2014. doi: 10.3748/wjg.v20.i24.7760
Large balloon dilation post endoscopic sphincterotomy in removal of difficult common bile duct stones: A literature review
Olivier Rouquette, Gilles Bommelaer, Armando Abergel, Laurent Poincloux
Olivier Rouquette, Gilles Bommelaer, Armando Abergel, Laurent Poincloux, Digestive Endoscopy Unit, CHU Estaing, 63000 Clermont-Ferrand, France
Author contributions: Rouquette O and Poincloux L collected data and drafted the article; Bommelaer G and Abergel A revised the paper.
Correspondence to: Olivier Rouquette, MD, Digestive Endoscopy Unit, CHU Estaing, 1 Pl Lucie et Raymond Aubrac, 63000 Clermont-Ferrand, France. orouquette@chu-clermontferrand.fr
Telephone: +33-473-750523 Fax: +33-473-750524
Received: November 1, 2013
Revised: January 27, 2014
Accepted: March 12, 2014
Published online: June 28, 2014
Processing time: 241 Days and 4.6 Hours
Abstract

Endoscopic sphincterotomy (ES) is the standard therapy in common bile duct (CBD) stones extraction. Large stones (≥ 12 mm) or multiple stones extraction may be challenging after ES alone. Endoscopic sphincterotomy followed by large balloon dilation (ESLBD) has been described as an alternative to ES in these indications. Efficacy, safety, cost-effectiveness and technical aspects of the procedure have been here reviewed. PubMed and Google Scholar search resulted in forty-one articles dealing with CBD stone extraction with 12 mm or more dilation balloons after ES. ESLBD is at least as effective as ES, and reduces the need for additional mechanical lithotripsy. Adverse events rates are not statistically different after ESLBD compared to ES for pancreatitis, bleeding and perforation. However, particular attention should be paid in patients with CBD strictures, which is identified as a risk factor of perforation. ESLBD is slightly cost-effective compared to ES. A small sphincterotomy is usually performed, and may reduce bleeding rates compared to full sphincterotomy. Dilation is performed with 12-20 mm enteral balloons. Optimal inflation time is yet to be determined. The procedure can be performed safely even in patients with peri-ampullary diverticula and surgically altered anatomy. ESLBD is effective and safe in the removal of large CBD stones, however, small sphincterotomy might be preferred and CBD strictures should be considered as a relative contraindication.

Keywords: Bile duct stone; Endoscopic papillary large balloon dilation; Endoscopic sphincterotomy; Endoscopic retrograde cholangiopancreatography; Mechanical lithotripsy

Core tip: Endoscopic sphincterotomy followed by large balloon dilation is actually routinely performed in difficult stones extraction. The efficacy and safety of this procedure has been evaluated in thirty-two original studies published in English. Severe adverse events have been reported. This review describes indications, efficacy, morbidity and technical aspects of this procedure and tries to provide helpful data to the endoscopists in order to improve patient outcomes.