Published online Dec 28, 2017. doi: 10.3748/wjg.v23.i48.8597
Peer-review started: August 15, 2017
First decision: August 29, 2017
Revised: October 31, 2017
Accepted: November 14, 2017
Article in press: November 14, 2017
Published online: December 28, 2017
Processing time: 135 Days and 0.1 Hours
Endoscopic papillary large balloon dilatation (EPLBD) is an established technique for biliary stone extraction mainly in Asia. Serious adverse events related to EPLBD including pancreatitis, bleeding and perforation have limited its wider utility particularly in the Western world. Timing and size of preceding endoscopic sphincterotomy (EST) impose significant concerns regarding serious procedure related adverse events. This study describes the safety and efficacy of EPLBD in the management of CBDS and examines the impact of timing and size of sphincteroplasty in relation to EST in a Western population.
EPLBD is being performed very frequently in day to day practice. There is insufficient data on its efficacy and safety without any standardized techniques. There is little data on timing and hence an appreciation that there is variation in practice in some centres performing a sphincteroplasty on a subsequent and further endoscopic retrograde cholangiopancreatography. The principal motive of the study was to ascertain whether EPLBD could be performed safely as an effective and preferred endoscopic modality for complex biliary stone extraction following EST.
The main objectives of the study were to describe the efficacy and safety of EPLBD in the management of bile duct stones in a Western population from the experience in a busy tertiary referral unit.
This was a retrospective observational study in which consecutive patients who underwent EPLBD during the defined period were evaluated based on study endpoints.
This study confers high safety profile of EPLBD for biliary stone extraction in relation to an EST. The study also ascertains EPLBD as an effective and preferred endoscopic modality than standard endoscopic techniques for complex bile duct stones management. The problems that remain to be solved are the predictive factors indicating the need for EPLBD and factors predicting failure.
EPLBD is a safe and effective technique for biliary stone extraction. Safety of large balloon sphincteroplasty is not influenced by the presence of a periampullary diverticulum or a fresh sphincterotomy. Limited or full sphincterotomy followed by EPLBD does not influence the outcomes. Large and multiple stones may predict need for additional treatment modalities including cholangioscopy and electrohydraulic lithotripsy where large balloon sphincteroplasty remains unsuccessful in achieving duct clearance.
This study suggests that large balloon sphincteroplasty can be performed and repeated safely and effectively in those with a sphincterotomy irrespective of its timing and size to establish complete duct clearance.