Comparison of Endoscopic Papillary Balloon Dilatation and Sphincterotomy for Lithotripsy in Difficult Sphincterotomy

Background Endoscopic papillary balloon dilatation is as effective as sphincterotomy for lithotripsy with a lower risk of hemorrhage, but a higher risk of pancreatitis has been reported. It has been suggested as an alternative to sphincterotomy when sphincterotomy is difficult because of periampullary diverticulum or prior sphincterotomy, but comparison with sphincterotomy in these conditions has not been studied. Aim To compare the efficacy and safety between balloon dilatation and sphincterotomy for lithotripsy when sphincterotomy is difficult because of periampullary diverticulum or prior sphincterotomy. Methods Eighty patients with difficult endoscopic sphincterotomy because of periampullary diverticulum or prior sphincterotomy underwent balloon dilatation (n=46) or sphincterotomy (n=34) for lithotripsy. The success of stone clearance and complications were reviewed and compared. Results In the subgroup of periampullary diverticulum, balloon dilatation was more effective than sphincterotomy in stone clearance (100% vs. 84%, P=0.026). The rate of overall complications and pancreatitis (5.7% and 5.7%) was lower after balloon dilatation than after sphincterotomy (20% and 12%) (P=0.026 and 0.029, respectively). In the subgroup of prior sphincterotomy, no difference in efficacy or safety was noted between balloon dilatation and sphincterotomy. Conclusions Balloon dilatation was more effective and safer than sphincterotomy for lithotripsy when sphincterotomy was difficult because of periampullary diverticulum. Balloon dilatation was as effective and safe as sphincterotomy after prior sphincterotomy. As balloon dilatation is easier to perform, it may be the preferred treatment when sphincterotomy is difficult because of periampullary diverticulum or prior sphincterotomy.

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