To Cut or Stretch?

Endoscopic papillary balloon dilation (EPBD) offers an alternative to endoscopic sphincterotomy (EST), which preserves the barrier function of the biliary sphincter. However, reports of increased complications, especially pancreatitis, have stalled the widespread adoption of this technique. A metaanalysis of randomized trials of EPBD versus EST found similar overall complication rates (10.5%vs 10.3%). However, while postprocedure bleeding was reduced with EPBD compared to EST (0%vs 2.0%), the rate of postprocedure pancreatitis was higher (7.4%vs 4.3%). In addition, 20% of EPBD cases required “rescue” EST. EPBD should probably be reserved for special indications, such as uncorrected or anticipated coagulopathy, and unfavorable endoscopic anatomy for EST.

[1]  N. Uchida,et al.  Papillary dilation vs sphincterotomy in endoscopic removal of bile duct stones a randomized trial with manometric function , 1995, Digestive Diseases and Sciences.

[2]  T. Baron,et al.  Endoscopic Balloon Dilation of the Biliary Sphincter Compared to Endoscopic Biliary Sphincterotomy for Removal of Common Bile Duct Stones During ERCP: A Metaanalysis of Randomized, Controlled Trials , 2004, American Journal of Gastroenterology.

[3]  T. Baron,et al.  Endoscopic Balloon Dilation of the Biliary Sphincter Compared to Endoscopic Biliary Sphincterotomy for Removal of Common Bile Duct Stones During ERCP: A Meta-analysis of Randomized, Controlled Trials , 2004 .

[4]  X Viviand,et al.  Complications of Endoscopic Sphincterotomy: Results From a Single Tertiary Referral Center , 2002, Endoscopy.

[5]  H. Asakura,et al.  What is an appropriate indication for endoscopic papillary balloon dilation? , 2002, European journal of gastroenterology & hepatology.

[6]  E. G. Hahn,et al.  Complications of endoscopic sphincterotomy: can heparin prevent acute pancreatitis after ERCP? , 2002, Gastrointestinal endoscopy.

[7]  H. Moriwaki,et al.  Can endoscopic papillary balloon dilation really preserve sphincter of Oddi function? , 2001, Gut.

[8]  L. Lepre,et al.  Late Development of Bile Duct Cancer in Patients Who Had Biliary-Enteric Drainage for Benign Disease: A Follow-Up Study of More Than 1,000 Patients , 2001, Annals of surgery.

[9]  J. Riemann,et al.  Endoscopic Papillary Balloon Dilation vs. Sphincterotomy for Removal of Common Bile Duct Stones: A Prospective Randomized Pilot Study , 2001, Endoscopy.

[10]  K. Huibregtse.  Endoscopic balloon dilation for removal of bile duct stones: special indications only. , 2001, Endoscopy.

[11]  J. Tijssen,et al.  A randomized trial of endoscopic balloon dilation and endoscopic sphincterotomy for removal of bile duct stones in patients with a prior Billroth II gastrectomy. , 2001, Gastrointestinal endoscopy.

[12]  N. Ueno,et al.  Endoscopic sphincter dilation in patients with bile duct stones: Immediate and medium‐term results , 1999, Journal of gastroenterology and hepatology.

[13]  J. Baillie.  Biliary sphincterotomy: Less benign than once thought? , 1999, Current gastroenterology reports.

[14]  T. Akamatsu,et al.  Comparing the treatment outcomes of endoscopic papillary dilation and endoscopic sphincterotomy for removal of bile duct stones , 1999, Journal of gastroenterology and hepatology.

[15]  P. Fina,et al.  Major early complications from diagnostic and therapeutic ERCP: a prospective multicenter study. , 1998, Gastrointestinal endoscopy.

[16]  S. Kanai,et al.  Overexpression of Cholecystokinin-B/ Gastrin Receptor Gene in the Stomach of Naturally Occurring Cholecystokinin-A Receptor Gene Knockout Rats , 1998, Digestion.

[17]  G. Tytgat,et al.  Biliary manometry, bacterial characteristics, bile composition, and histologic changes fifteen to seventeen years after endoscopic sphincterotomy. , 1997, Gastrointestinal endoscopy.

[18]  M. Sasaki,et al.  Late development of bile duct cancer after sphincteroplasty: a ten- to twenty-two-year follow-up study. , 1997, Surgery.

[19]  J. Tijssen,et al.  Randomised trial of endoscopic balloon dilation versus endoscopic sphincterotomy for removal of bileduct stones , 1997, The Lancet.

[20]  T. Zágoni,et al.  Complications of endoscopic biliary sphincterotomy. , 1997, The New England journal of medicine.

[21]  F. Prat,et al.  Endoscopic sphincteroclasy: a useful therapeutic tool for biliary endoscopy in Billroth II gastrectomy patients. , 1997, Endoscopy.

[22]  M E Ryan,et al.  Complications of endoscopic biliary sphincterotomy. , 1996, The New England journal of medicine.

[23]  J. Crowe,et al.  Endoscopic balloon sphincteroplasty (papillary dilation) for bile duct stones: efficacy, safety, and follow-up in 100 patients. , 1995, Gastrointestinal endoscopy.

[24]  P. Cotton,et al.  Removal of stones from the bile duct at ERCP without sphincterotomy. , 1993, Gastrointestinal endoscopy.

[25]  R. Kozarek.  Balloon dilation of the sphincter of Oddi. , 1988, Endoscopy.

[26]  K. Ewe,et al.  ENDOSCOPIC PAPILLARY DILATATION, A POSSIBLE ALTERNATIVE TO ENDOSCOPIC PAPILLOTOMY , 1982, The Lancet.

[27]  M. Tada,et al.  Endoscopic sphincterotomy of the ampulla of Vater , 1974 .

[28]  M. Classen,et al.  Endoskopische Sphinkterotomie der Papilla Vateri und Steinextraktion aus dem Ductus choledochus , 1974 .