Endoscopic papillary large balloon dilation after limited sphincterotomy for difficult biliary stones

To assess the efficacy and safety of endoscopic papillary large balloon dilation after biliary sphincterotomy for difficult bile duct stones retrieval.

Retrospective review of consecutive patients submitted to the technique during 18 mo. The main outcomes considered were: efficacy of the procedure (complete stone clearance; number of sessions; need of lithotripsy) and complications.

A total of 30 patients with a mean age of 68 ± 10 years, 23 female (77%) and 7 male (23%) were enrolled. In 10 patients, a single stone was found in the common bile duct (33%) and in 20 patients multiple stones (67%) were found. The median diameter of the stones was 17 mm (12-30 mm). Dilations were performed with progressive diameter Through-The-Scope balloons (up to 12, 15) or 18 mm. Complete retrieval of stones was achieved in a single session in 25 patients (84%) and in two sessions in 4 patients (13%). Failure occurred in 1 case (6%). Mechanical lithotripsy was performed in 6 cases (20%). No severe complications occurred. One patient (3%) had mild-grade post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis.

Endoscopic balloon dilatation with a large balloon after endoscopic sphincterotomy is a safe and effective technique that could be considered an alternative choice in therapeutic ERCP.