Published online Mar 16, 2015. doi: 10.4253/wjge.v7.i3.274
Peer-review started: August 29, 2014
First decision: October 28, 2014
Revised: December 16, 2014
Accepted: January 9, 2015
Article in press: January 12, 2015
Published online: March 16, 2015
Processing time: 204 Days and 20.6 Hours
Large bile duct stone (> 10 mm) or multiple stones (≥ 3) are challenging for endoscopists. Endoscopic sphincterotomy (EST) is a routine therapeutic endoscopic retrograde cholangiopancreatography (ERCP) procedure usually used. It is safe and effective, but severe perforation or massive bleeding are the main causes of mortality. Because of the permanent destroy of Oddi sphincter, the use of EST is still controversial. Endoscopic papillary balloon dilation (EPBD) gives another way to open the sphincter. Less incidence of bleeding, perforation and partly preserving the Oddi sphincter’s function are the main advantages. But high incidence of post-ERCP pancreatitis becomes a predominant problem. According to the anatomical feature of Oddi sphincter, limited EST + EPBD seems a more reasonable procedure. Compared to the former two procedures, it makes the stone extraction process much easier with lower incidences of short-term and long-term complications.
Core tip: This review describes endoscopic sphincterotomy (EST), endoscopic papillary balloon dilation (EPBD) and limited EST + EPBD in the treatment of difficult bile duct stones. We analyze the advantages and disadvantages of these procedures from a unique anatomic view. Limited EST + EPBD may be the most reasonable procedure with the highest successful rate and the lowest incidence of complications.