Sixty- versus thirty-seconds papillary balloon dilation after sphincterotomy for the treatment of large bile duct stones: A randomized controlled trial

Endoscopic papillary large balloon dilation and endoscopic papillary balloon dilation both without sphincterotomy for removal of large bile duct stones: A propensity‐matched analysis

“…In our study, PEP developed in 9.1% including one severe case, which appeared higher than in previous reports . Although longer ballooning time decreased PEP during EPBD in the previous randomized controlled trial (RCT), we did not find any differences between EPBD taking 5 min or EPBD taking 15 s to carry out, and the effect of longer ballooning time during EPLBD is still controversial . At least, EPLBD without EST could be indicated when EST is difficult or risky (i.e.…”

International consensus guidelines for endoscopic papillary large-balloon dilation

“…Thereafter, a number of case series supported the finding that supplementary EPLBD after mainly large EST was a feasible and useful technique in similar situations. 37,39-43 However, several severe to fatal adverse events (1 case of fatal pancreatitis, 42 2 cases of severe bleeding, 39,40 1 case of fatal bleeding, 43 and 1 case of severe perforation 40 ) have been described in published reports. One well-conducted randomized, controlled trial reported that full-incision EST followed by EPLBD was equally as effective as full-incision EST followed by EML for the removal of large bile duct stones, but associated with fewer adverse events (4.4% vs 20%, P Z .049).…”

“…18 One randomized, controlled trial reported that a 30-second duration of balloon dilation was not different from a 60-second duration with regard to adverse events, including pancreatitis, bleeding, and perforation in EPLBD with EST. 42 One randomized, controlled study on the duration of balloon dilation by using a small-diameter balloon reported that 5-minute EPBD improved the efficacy of stone extraction and reduced the risk of pancreatitis compared with conventional 1-minute EPBD. 50 When studies were stratified by different durations of balloon dilation in a meta-analysis of EPLBD studies by Feng et al, 31 the rates of bile duct stone clearance were not significantly different between EPLBD and EST alone, despite EPLBD being performed with either short duration (<1 minute) (OR 2.77; 95% CI, 0.80-9.61; P Z .11) or long duration (!1 minute) (OR 0.56; 95% CI, 0.18-1.78; P Z .33).…”

Large bile duct stones

“…In a RCT of 124 patients with large CBD stones, Paspatis and colleagues evaluated the efficacy of ES followed by 30 versus 60 s dilation using a maximum balloon diameter of 20 mm, and found similar rates of successful bile duct clearance and complications [25].…”