Reappraisal of endoscopic papillary balloon dilation for themanagement of common bile duct stones

• 作者: Hoi-Hung Chan Jin-Shiung Cheng Kwok-Hung Lai Ping-I Hsu Tzung-Jiun Tsai
• 来源期刊: 世界胃肠内镜杂志：英文版（电子版）
• 学科: 医学
• 关键词: Common BILE duct STONES Complications ENDOSCOPIC balloon DILATION ENDOSCOPIC large balloondilation ENDOSCOPIC SPHINCTEROTOMY
• 年，卷（期）: 2015,（2）
• 页码范围: 77-86
• 页数: 10页
• 分类号: R

摘要

Although endoscopic sphincterotomy （EST） is stillconsidered as a gold standard treatment for commonbile duct （CBD） stones in western guideline, endoscopicpapillary balloon dilation （EPBD） is commonly used bythe endoscopists in Asia as the first-line treatment forCBD stones. Besides the advantages of a technical easyprocedure, endoscopic papillary large balloon dilation（EPLBD） can facilitate the removal of large CBD stones.The indication of EPBD is now extended from removal of the small stones by using traditional balloon, to removal of large stones and avoidance of lithotripsy by using large balloon alone or after EST. According to the reports of antegrade papillary balloon dilatation, balloon dilation itself is not the cause of pancreatitis. On the contrary, adequate dilation of papillary orifice can reduce the trauma to the papilla and pancreas by the basket or lithotripter during the procedure of stone extraction. EPLBD alone is as effective as EPLBD with limited EST. Longer ballooning time may be beneficial in EPLBD alone to achieve adequate loosening of papillary orifice. The longer ballooning time does not increase the risk of pancreatitis but may reduce the bleeding episodes in patients with coagulopathy. Slowly inflation of the balloon, but not exceed the diameter of bile duct and tolerance of the patients are important to prevent the complication of perforation. EPBLD alone or with EST are not the sphincter preserved procedures, regular follow up is necessary for early detection and management of CBD stones recurrence.