Tips in biliary stone removal using endoscopic papillary large balloon dilation

Abstract

The use of limited endoscopic sphincterotomy with large balloon dilation (ESLBD) has recently been shown to be useful for removal of large common bile duct stones in a dilated bile duct. The technique can reduce the need of mechanical lithotripsy, risk of adverse events and costs of the procedure. The aim of the review is to provide an overview in the current status of ESLBD with particular focus on the technical aspects of the technique for bile duct stone removal.

Japan Gastroenterological Endoscopy Society guidelines for endoscopic papillary large balloon dilation

“…Thus, there is presently no clear evidence regarding the incidence of procedural events and balloon diameter. In reference to an expert opinion based on animal experiments, it has been suggested that the use of a balloon ≥15 mm in diameter should be avoided as much as possible as it increases the risk of perforation . However, many experts advocate selecting a balloon diameter that does not exceed the range of the bile duct diameter and the short diameter of the stone.…”

“…In reference to an expert opinion based on animal experiments, it has been suggested that the use of a balloon ≥15 mm in diameter should be avoided as much as possible as it increases the risk of perforation. 45 However, many experts [46][47][48] advocate selecting a balloon diameter that does not exceed the range of the bile duct diameter and the short diameter of the stone. Regarding the measurement of the bile duct diameter, the distal bile duct is narrow in some patients 46 and therefore the diameter of the distal bile duct should be measured.…”

“…Furthermore, intrabiliary emphysema tends to develop after EPLBD, thus it is recommended to perform the procedure under CO 2 insufflation as a countermeasure for procedural accidents such as air ambolism . Surgical treatment is indicated when no improvement is observed with conservative treatment and in the event of gastrointestinal perforation, taking into consideration that the prognosis becomes poor if diagnosis and treatment are delayed . Notably, there have only been few cases reported regarding the mechanism and treatment of perforation following EPLBD, and more cases should be evaluated.…”

Repeated balloon inflation under low pressure may reduce serious adverse events during endoscopic papillary large balloon dilation

“…The associated adverse events including pancreatitis, bleeding, and perforation are caused by excessively high balloon pressure. [1][2][3][4][5] Therefore, we devised a new technique for EPLBD to avoid high balloon pressure.…”

“…Endoscopic papillary large balloon dilation (EPLBD) has been recently introduced to remove large common bile duct stones (CBDSs). The associated adverse events including pancreatitis, bleeding, and perforation are caused by excessively high balloon pressure 1–5 . Therefore, we devised a new technique for EPLBD to avoid high balloon pressure.…”