Endoscopic Diagnosis of Biliary Tract Lesions Using Hydrostatic Balloon Sphincter Dilation: A Preliminary Experience

We report some encouraging results of endoscopic balloon sphincter dilation (EBSD) and discuss its clinical relevance in the diagnosis of bile duct lesions by endoscopically accessing the biliary tree. Endoscopic approach to the bile duct was performed in seven patients with various biliary tract diseases (bile duct cancer in 2 cases, pancreatic cancer in 1, Caroli disease with bile duct stones in 1, gallbladder cancer in 1, and hepatocellular carcinoma in 2) after passing a baby scope through the papilla of Vater using EBSD. The instrument used was a Maxforce 5 French balloon-tipped biliary catheter for EBSD, an Olympus CHF-BP30 or Pentax FCP-9P baby fiberscope, and an Olympus TJF-M20 mother fiberscope for endoscopic examination. Using EBSD, it was possible to advance a baby fiberscope through the papilla of Vater in all cases. In 6 patients, endoscopic observation was successfully achieved. Apart from minimal self-limiting venous oozing seen following balloon deflation, there was no papillary hemorrhage or perforation observed. Pancreatitis developed in one patient and was resolved within 24 hours. Although our series is limited and several technical issues remain to be solved, this new procedure has potential for endoscopic diagnosis of biliary tract lesions. One of the major advantages may lie in the possibility of preserving sphincter function. We favor the use of EBSD for diagnostic evaluation of bile duct diseases.