内镜下十二指肠乳头括约肌小切开术联合球囊扩张术治疗胆管结石的疗效观察

目的 探讨内镜下乳头括约肌小切开术（smallendoscopicsphincterotomy,SEST）联合球囊扩张术（endo—scopicpapillaryballoondilatation,EPBD）治疗胆管结石的远期疗效和并发症。方法选择青岛市海慈医疗集团消化内科2009年3月至2011年12月住院治疗的127例结石直径〉10mm的胆管结石患者,随机分为4组,SEST＋EPBD组33例,先行乳头括约肌小切开（切开范围小于乳头肌三分之一）,然后球囊扩张,再碎石取石;EPBD＋SEST组32例,先行球囊扩张术,再行乳头括约肌小切开,再碎石取石;EST组32例,仅行十二指肠乳头括约肌大切开（切开范围大于乳头肌三分之二）取石;EPBD组30例,仅行球囊扩张碎石取石。比较4组的疗效和并发症发生率。结果SEST＋EPBD组术后结石取净率为93．93％（31／33）,EPBD＋SEST组为93．75％（30／32）,EST组为96．77％（30／31）,EPBD组为66．67％（20／30）,EPBD组与其他三组比较差异有统计学意义（P〈0．05）;SEST＋EPBD组和EPBD＋SEST组均无远期并发症发生,EST组远期并发症发生率为16．67％,EPBD组为3．57％,EST组与其他三组比较有显著性差异（P〈0．05）。结论SEST与EPBD联合治疗胆管结石安全有效,可有效降低经内镜治疗胆管结石的远期并发症发生率,提高胆管结石患者术后的生活质量。     

内镜下乳头球囊扩张术和乳头括约肌切开术治疗胆总管结石的比较

目的 探讨内镜下乳头球囊扩张术(EPBD)治疗胆总管结石的有效性和安全性.方法 2005年6月至2007年5月山东大学齐鲁医院320例拟行内镜下取石的胆总管结石患者,随机分为EPBD组及内镜下乳头括约肌切开术(EST)组,每组160例.EPBD组在乳头球囊扩张后用取石网篮或气囊取石,当结石较大时先行机械碎石网篮碎石后再取石;EST组按常规操作.两组术后均常规鼻胆管引流3 d,并造影复查.结果 EST组及EPBD组分别有156例(97.5%)及157例(98.1%)成功取净结石,其中各有112例(70.0%)及104例(65.0%)一次完成;机械碎石网篮应用比例分别为20.0%(32/160)和22.5%(36/160);术后早期并发症的总发生率分别为5.6%及8.1%,无死亡病例.随访3年,EST组胆管结石复发率(7.5%)高于EPBD组(2.5%),P＜0.05.结论 EPBD取石具有与EST取石相近的成功率,经术后常规鼻胆管引流处理后,胰腺炎发生率无明显升高.EPBD可以作为胆总管结石的备选治疗措施,尤其是对不适于EST的患者.

Abstract：

Objective To explore the effectiveness and safety of endoscopic papillary balloon dilation( EPBD ) for the removal of common bile duct stones. Methods Three hundred and twenty consecutive patients with common bile duct stones on endoscopic retrograde cholangiopancreatography (ERCP) who met all eligibility criteria were randomly assigned endoscopic sphincterotomy (EST) or EPBD.Complications were classified by an expert panel unaware of treatment allocation and outcome. Results After a single ERCP, all stones were removed from 112 patients ( 70% ) assigned EST and 104 ( 65% )assigned EPBD. Mechanical lithotripsy was used to fragment stones in 36 (22. 5% ) EPBD procedures and 32 ( 20. 0% ) EST procedures. Early complications occurred in 5.6% EST patients and 8.1% EPBD patients. No patient died. Gallstone disease recurrence, which is a long-term complication, is 7. 5% ( 12/160) in EST patients and 2.5% (4/160) in EPBD patients, P ＜0. 05. Conclusions The success rate of EPBD was similar to that of EST. We found no evidence of previously suggested higher risk of pancreatitis with EPBD, and suggest that EPBD is preferred in patients who are not suitable for EST, such as those with high risk of bleeding. This procedure is a valuable alternative to EST in patients with bile duct stones.     

内镜下乳头括约肌小切开联合气囊扩张术在胆总管结石治疗中的应用价值

目的探讨内镜下乳头括约肌小切开联合气囊扩张术在胆总管结石治疗中的效果和安全性。方法选取胆总管结石患者46例行乳头括约肌小切开联合气囊扩张术取石,观察治愈率,近期、远期并发症。结果取石成功率为95.7%;近期并发症发生率为6.5%,其中急性胰腺炎1例,胆管炎2例,远期并发症发生率为4.4%,反流性胆管炎、结石复发各1例。结论内镜下乳头括约肌小切开联合气囊扩张术治疗胆总管结石,与乳头括约肌切开取石术同样有效,且安全性更好,操作更简单。     

十二指肠镜2种方法治疗胆管结石的比较

目的比较分析内镜下十二指肠乳头括约肌切开术（EST）和十二指肠乳头球囊扩张术（EPBD）治疗胆总管结石的临床疗效。方法选取河池市人民医院及右江民族医学院附属医院2010年3月2011年10月住院治疗的60例胆管结石患者,其中38例进行EST治疗,22例进行EPBD治疗．比较两组的疗效及并发症的发生率。结果EST组术后结石取净率为94．74％,EPBD组为95．45％．两者比较差异无统计学意义（x2=0．015,P〉0．05）;EST组近期并发症的发生率为5．56％明显低于EPBD组的23．80％（X2=4．102,P〈0．05）;EPBD组胰腺炎的发生率为19．04％明显高于EST组的2．78％（X2=4．387,P〈0．05）。EST组远期并发症的发生率为19．4％,而EPBD组未出现远期并发症,二者有显著性差异（x2=4．655,P〈0．05）。结论EST术和EPBD术治疗胆总管结石的结石清除率接近,但EST的并发症特别是术后胰腺炎的发生率较低,而EPBD的远期并发症较低,说明两种方法各有利弊,但均安全有效,临床应根据患者结石数目和结石大小选择适合的手术方式。     

内镜下十二指肠乳头小切开后球囊扩张术治疗胆总管结石的临床研究

目的探讨内镜下十二指肠乳头括约肌小切开后球囊扩张术在胆总管结石治疗中的有效性和安全性。方法将150例临床确诊为胆总管结石的患者随机分为乳头括约肌切开组(EST组)和乳头括约肌小切开后球囊扩张术组(SEST+EPBD组),比较两组疗效及并发症的发生率。结果 EST组和SEST+EPBD组取石成功率分别为92%和97%(χ2=1.19,P0.05)。EST组术后出现急性胰腺炎2例,出血4例,结石复发11例,逆行性胆道感染15例。SEST+EPBD组术后出现急性胰腺炎1例,出血1例,结石复发2例,逆行性胆道感染6例。两组取石成功率及近期并发症比较差异无统计学意义(P0.05),远期并发症比较差异有统计学意义(P0.05)。结论内镜下乳头括约肌小切开后球囊扩张术治疗胆总管结石安全、有效,并发症少,并且尽可能的保留了十二指肠乳头括约肌的功能,值得临床推广。     

经内镜乳头括约肌切开术与气囊扩张术治疗胆总管结石临床评价

目的:评价经内镜乳头括约肌切开术(EST)和气囊扩张术(EPBD)联合机械碎石(EML)治疗胆总管结石的临床疗效．方法:选取我院住院胆总管结石患者60例,随机分成EST组(n=30)和EPBD组(n=30),分别采用EST和EPBD联合机械碎石进行内镜下取石．观察二组的治愈率,近期并发症、远期并发症．结果:正结果EST组与EPBD组的取石成功率为93．3％和90％．无显著性差异(P>0．05): 两组近期并发症发生率(包括胰腺炎、胆道感染、出血)为30％和13．3％,无显著性差异 (P>0．05);而远期并发症(包括胆道感染、结石复发)26．7％和3.3％,有显著性差异(P<0．05)．结论:EST和EPBD的结石清除率及近期并发症相似,但EPBD远期并发症的发病率较低, 表明EPBD能够在一定程度上保护Oddi括约肌功能。     

十二指肠乳头括约肌小切开联合气囊扩张治疗难治性胆总管结石的疗效评价

目的 探讨乳头括约肌小切开联合气囊扩张治疗难治性胆总管结石的效果和安全性.方法 将2008年3月至2009年12月收治的难治性胆总管结石患者随机分为两组,分别为乳头括约肌切开组及乳头括约肌小切开联合气囊扩张组,比较两组间结石取净率、取石次数、机械碎石使用率、并发症发生率.结果 两组间结石取净率、早期并发症发生率,差异无统计学意义（2/61比2/62,6/61比4/62;P＞0.05）;乳头括约肌切开组需多次及需要使用机械碎石才能取净结石的比例以高于乳头括约肌小切开联合气囊扩张组,率差异有统计学意义（15/61比5/62,12/6l比4/62;P＜0.05）.结论 乳头括约肌小切开联合气囊扩张与乳头括约肌切开两种方法同样安全有效;乳头括约肌小切开联合气囊扩张操作更简便.     

改良内镜下乳头气囊扩张术应用的可行性研究

目的探讨改良内镜下乳头气囊扩张术（EPBD）治疗胆管结石的可行性。方法对226例肝外胆管结石的患者应用肠道型柱状气囊行乳头扩张并在此基础上展开治疗，并比较2299例内镜乳头切开术（EST）的治疗效果及术后并发症情况。结果226例患者均顺利完成取石或碎石取石术，术后无胆道感染、穿孔等并发症，发生轻型急性胰腺炎4．7％（10例），与EST（5．2％）比较，差异无统计学意义，术后消化道出血0．47％（1例），与EST（1．2％）比较，差异有统计学意义。结论对EST困难或易发生并发症者用肠道型柱状气囊行EPBD术，能有效地钝性切割乳头，并在此基础上展开较大结石的取石或碎石取石术，同时并发症明显减少。EPBD是内镜下处理胆管结石安全有效的方法之一。     

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

OBJECTIVES: To compare the effect of endoscopic balloon dilation (EPBD) of the papilla with that of endoscopic biliary sphincterotomy (EST) in the treatment of patients with common bile duct stones. METHODS: Searches of computerized bibliographic and scientific citations, and review of citations in relevant primary articles. Eight fully published prospective, randomized trials in English that compared EPBD with EST for the removal of common bile duct stones were subjected to metaanalysis. RESULTS: EPBD compared with EST resulted in similar outcomes with regards to overall successful stone removal (94.3% vs 96.5%) and overall complications (10.5% vs 10.3%). Bleeding occurred less frequently with EPBD (0% vs 2.0%, p = 0.001). Post-ERCP pancreatitis occurred more commonly in the EPBD group (7.4% vs 4.3%, p = 0.05). No significant differences were seen in the rates of perforation or infection. Patients undergoing EPBD were more likely to require mechanical lithotripsy for stone extraction (20.9% vs 14.8%, p = 0.014). CONCLUSIONS: On the basis of lower rates of bleeding, EPBD should be the preferred strategy over EST for endoscopic removal of common bile duct stones in patients with coagulopathy. Although EPBD is theoretically attractive for use in young patients for biliary sphincter preservation, the rate of pancreatitis is higher with EPBD and cannot be routinely recommended at this time.     

内镜治疗胆总管结石的临床研究

目的 探讨内镜在胆总管探查取石中的应用价值。方法 对227例拟诊胆总管结石 的患者采用经内镜治疗,其中14例直径<1.0 cm的结石采用经内镜乳头球囊扩张术治疗,194例直 径1.0-1.5cm的结石采用内镜乳头括约肌切开治疗,19例直径>1.5cm的结石采用内镜下机械碎 石治疗。结果 15％(34例)胆管造影未见结石,经内镜探查阴性。余193例中,187例取石成功,成 功率为96.9％(187／193)。并发症发生率为5.29%(12／227),其中急性胆管炎3例,急性胰腺炎8 例,消化道出血1例。结论 内镜治疗胆总管结石安全有效,并发症少,应当首选。但对ERCP无法 明确的胆总管结石,不主张行乳头括约肌切开及内镜下的胆管探查,以最大限度地减少并发症。     

Efficacy and safety of low-pressured and short-time dilation in endoscopic papillary balloon dilation for bile duct stone removal

Background and Aim:  Endoscopic papillary balloon dilation (EPBD) has been advocated as an alternative therapy to endoscopic sphincterotomy for bile duct stones. However, studies have shown that EPBD may increase the risk for pancreatitis. Pancreatitis after EPBD is believed to be related to papillary damage after balloon dilation. We changed the dilation method to a theoretically less hazardous one. This modified dilation method was compared with the initial method.
Methods:  A total of 324 patients with bile duct stones underwent EPBD by the modified method between June 1999 and June 2003. Three hundred and twenty-four patients undergoing EPBD by the initial method served as a historical control group. The success rate of stone removal and the incidence of procedure-related pancreatitis were compared between the two groups. In the modified method, the balloon was inflated until disappearance of the balloon waist, and the pressure was then maintained for 15 s. In the initial method, the balloon was inflated at 8 atmospheres for 2 min.
Results:  Bile duct stones were successfully removed in 313 of 324 patients (96.6%) in the modified group and in 314 of 324 patients (96.9%) in the initial group (not significant). The incidence of postprocedure pancreatitis showed a lower tendency in the modified group (4.0%, 13/324) than in the initial group (7.4%, 24/324) ( P -value = 0.0626). The severity of pancreatitis was significantly reduced in the modified group.
Conclusion:  The modified method of EPBD is feasible for extraction of bile duct stones, and may potentially decrease the incidence of severe post-EPBD pancreatitis.     

Reappraisal of endoscopic papillary balloon dilation for the management of common bile duct stones

Although endoscopic sphincterotomy(EST) is still considered as a gold standard treatment for common bile duct(CBD) stones in western guideline, endoscopic papillary balloon dilation(EPBD) is commonly used by the endoscopists in Asia as the first-line treatment for CBD stones. Besides the advantages of a technical easy procedure, 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.     

Efficacy and safety of endoscopic papillary balloon dilation for removal of common bile duct stones in the elderly

From May 1996 through August 1998, endoscopic papillary balloon dilation (EPBD) was performed to remove common bile duct stones in 17 elderly patients, aged 75 to 87 (average 81.9), including 7 with juxtapapillary diverticulum. The balloon-tipped biliary catheter for EPBD was inflated at a pressure of 10 atm, for 2 minutes, and the maximum diameter of the inflated balloon reached 8 or 10 mm. After one or two ERCP sessions using EPBD alone, the bile duct stones were removed in 16 (94.1%) of 17 patients, and endoscopic mechanical lithotripsy was required in 6 (35.3%) patients. Another patient required additional sphincterotomy for removal of the stone. Massive bleeding or intestinal perforation, which can be major complications of EPBD, did not occur, and while the minor complication of transient abdominal pain was observed in 3 patients but there was no case of pancreatitis. The clearance rates of stones and complication rates in our EPBD procedure were similar to other reports and to those of our data in younger patients, aged under 75. EPBD was a safe and effective technique for the extraction of the common bile duct stones in elderly patients.     

Current status of endoscopic papillary balloon dilation for the treatment of bile duct stones

Background/purpose

While endoscopic sphincterotomy (EST) is performed worldwide for the removal of common bile duct stones, many biliary endoscopists hesitate to regard endoscopic papillary balloon dilation (EPBD) as a standard procedure for treatment. Therefore, the aim of this review is to re-evaluate the status of EPBD for the treatment of common bile duct stones.

Results

A major benefit of EPBD is preservation of papillary function, which is not complete but may be greater than that after EST. The disadvantages of EPBD compared with EST are that EPBD is difficult to use for the removal of larger stones because of the smaller biliary opening, it requires more frequent use of mechanical lithotripsy, and it is associated with a higher incidence of pancreatitis, although the risks of bleeding and perforation are low. Since the biliary sphincter is easily dilated with a balloon catheter, EPBD may be effective for patients with anatomic anomalies, such as after gastric bypass surgery or in the presence of a periampullary diverticulum. No standard procedure exists to reduce the risk of acute pancreatitis with EPBD.

Conclusion

EPBD is feasible, however, we must pursue less hazardous techniques of papillary balloon dilation. Furthermore, we must understand the benefits and limitations of EPBD and determine whether it could provide clinical benefits for long-term complications.     

LONG‐TERM PROGNOSIS OF BILE DUCT STONES: ENDOSCOPIC PAPILLARY BALLOON DILATATION VERSUS ENDOSCOPIC SPHINCTEROTOMY

Aim: Endoscopic papillary balloon dilatation (EPBD), which allows preservation of papillary functions, is used as the first‐line therapy in our hospital for common bile duct (CBD) stones to reduce biliary complications. In the present study, we investigated causal factors for CBD stones and compared long‐term prognosis between EPBD and endoscopic sphincterotomy (EST). Methods: A total of 453 EPBD and 233 EST cases treated between April 1996 and May 2007 were examined. They were categorized into four groups: group 1, gallbladder (GB) with stones was resected after CBD stones were extracted (cholecystectomy for GB with stones); group 2, GB with stones was not resected after CBD stones were extracted (no cholecystectomy for GB with stones); group 3, only CBD stones were extracted while the GB without stones was not resected (GB without stones); and group 4, CBD stones with a history of cholecystectomy (absence of GB). Then, postoperative recurrence of CBD stones was compared. To examine changes in papillary functions by EPBD, Oddi's sphincter pressure was measured before and after EPBD. Results: Recurrence was observed in 31 EPBD and 40 EST cases. When recurrence rates by EPBD/EST were compared among the four treatment groups, they were lower with EPBD than with EST in all groups. Oddi's sphincter functions were preserved by 70% after EPBD. Conclusion: Low‐pressure EPBD in combination with isosorbide dinitrate enabled preservation of papillary functions by 70%, which would improve a long‐term prognosis.     

Endoscopic sphincterotomy and papillary balloon dilation for bile duct stones

BACKGROUND/AIMS: There are many reports of the results of endoscopic sphincterotomy (EST) for common bile duct stones. Recently, there were several reports on the results of endoscopic papillary balloon dilation (EPBD) for this condition. However, there have been few reports about a comparison between EST and EPBD. METHODOLOGY: Between Oct. 1994 and Dec. 1998, 196 consecutive patients underwent 102 EST or 94 EPBD. RESULTS: EST and EPBD were successful in 100 of 102 (98.0%), and all 94 patients. Bile duct clearance was achieved in 88 (88.0%) in the EST group and 88 (95.7%) in the EPBD group. Early complications occurred in 13 (13.0%: 3 acute pancreatitis, 4 cholangitis, 2 cholecystitis, 2 bleeding, 2 perforation) in the EST group and 16 (17.0%: 7 acute pancreatitis, 4 cholangitis, 4 cholecystitis, 1 basket impaction) in the EPBD group. Three patients (1 bleeding, 2 perforations) underwent emergent surgery after EST. CONCLUSIONS: The rate of bile duct clearance with EPBD was comparable to that with EST. Early complications did not differ between EST and EPBD. The use of EST tended to be associated with a lower incidence of acute pancreatitis, a higher incidence of bleeding, and a higher rate of perforation.     

Endoscopic papillary large balloon dilation for large common bile duct stones

Endoscopic papillary large balloon dilation (EPLBD) involves endoscopic biliary sphincterotomy (EBS) followed by balloon dilation using a 12–20-mm balloon to remove large or difficult stones from the common bile duct. The complications and limitations of endoscopic biliary sphincterotomy (EBS) are well known. Endoscopic papillary balloon dilation (EPBD) with a smaller diameter balloon but without sphincterotomy is widely used in a number of regions of the world for removal of routine bile duct stones and has been investigated as an alternative to EBS. EPBD, however, appears to be associated with an increased risk of pancreatitis. EPLBD differs from EPBD as it involves EBS followed by large balloon dilation. EPLBD would theoretically combine advantages of sphincterotomy and balloon dilation by increasing efficacy at stone extraction while minimizing complications of both EBS and EBD. A review of the available literature for EPBLD shows that it is relatively safe and effective. A high success rate (up to 95%) has been described for stone removal using EPLBD, with a low complication rate. Unlike EPBD, EBLBD does not appear to be associated with a higher risk of post-ERCP pancreatitis, probably because of separation of the biliary and pancreatic sphincters after EBS. EPLBD appears to be a reasonable option for removal of large or difficult common bile duct stones. This technique may be especially helpful in patients with difficult papillary anatomy, such as those with small papillae, intra- or peri-diverticular papilla. Its role in patients with coagulopathy or other risks for bleeding remains to be investigated.     

不同内镜术式治疗胆总管结石青年患者的长期随访研究

目的探讨不同的常用内镜治疗方法对胆总管结石青年患者治疗后结石复发的影响以及结石近期复发、远期复发的危险因素。方法选择经一次性治疗性内镜逆行胰胆管术（ERCP）成功取石后随访资料完整的胆总管结石青年（21～45岁）患者,按手术方式分为内镜下乳头球囊扩张术（EPBD）组、乳头括约肌切开术（EST）组、EST（切开〈0．5cm）＋EPBD组,进行随访,统计近期（≤3年）及远期（〉3年）结石复发率,并对复发危险因素进行Logistic回归分析。结果资料完整的327例患者平均随访76．5个月,54例（16．5％）结石复发,其中近期复发35例（10．7％）,远期复发19例（5．8％）。近期胆总管结石复发率EPBD组（11．3％）和EST组（13．2％）均高于EST＋EPBD组（8．1％）,但无统计学差异（P均〉0．05）。远期胆总管结石复发率EPBD组（11．3％）和EST组（6．6％）均显著高于EST＋EPBD组（0．8％）,差异具统计学意义（P均〈0．05）。Logistic回归分析结果表明,胆囊结石、结石最大径、结石个数、机械碎石与近期结石复发显著相关（P〈0．05）,而远期胆总管结石复发则与结石最大径及单纯球囊扩张显著相关（P〈0．05）。结论对于胆总管结石青年患者,单纯EPBD取石固然可保留乳头括约肌功能,但增加了结石的远期复发风险,而乳头括约肌小切开联合EPBD取石可显著降低胆总管结石复发率。     

What is an appropriate indication for endoscopic papillary balloon dilation?

OBJECTIVE: There are a number of views on the indication for endoscopic papillary balloon dilation (EPBD) in the management of bile duct stones. In this study, we have evaluated the efficacy and safety of EPBD compared with endoscopic sphincterotomy (EST). DESIGN: Prospective randomized trial. SETTING: One university hospital and one general hospital. PARTICIPANTS AND MAIN OUTCOME MEASURES: One hundred and forty patients were randomly allocated to EPBD or EST. Outcomes and complications were observed for a median period of 30 months. RESULTS: Both treatment approaches finally achieved similar success rates and needed similar numbers of treatment sessions for patients with stones less than 10 mm in diameter. However, for patients with stones of 10 mm or more, EPBD required a significantly greater mean number of treatment sessions than EST (2.4 vs 1.6, P < 0.01). Early complications occurred in seven EPBD (four pancreatitis, two cholangitis and one basket impaction) and eight EST (three pancreatitis, two bleeding and three cholangitis) patients. Late complications occurred in four EPBD (three recurrent bile duct stones and one cholecystitis) and six EST (three recurrent stones and three cholecystitis) patients. CONCLUSIONS: EPBD has little risk of bleeding. The technique removed small bile duct stones just as easily as did EST. These two procedures had approximately the same risk of pancreatitis and incidence of recurrent bile duct stones. Therefore, both procedures appear to be appropriate treatments for small bile duct stones. Whether or not EPBD becomes an established treatment will depend on further long-term studies.     

RISK MANAGEMENT FOR ENDOSCOPIC TREATMENT FOR COMMON BILE DUCT STONES: ENDOSCOPIC SPHINCTEROTOMY AND ENDOSCOPIC PAPILLARY BALLOON DILATION

Currently, endoscopic treatment for common bile duct stones is widely performed all over the world. Endoscopic sphincterotomy (EST) and endoscopic papillary balloon dilation (EPBD) are representative treatments of this modality in Japan. Both of them are much more convenient and much less invasive than surgical operation. These two procedures are also recognized as being relatively safe, but it is also a fact that serious complications may still occur at a certain rate. Bleeding, pancreatitis and duodenal perforation can occur in association with EST, and pancreatitis is the most important issue related to EPBD. To reduce the risk, these procedures should be performed only under the appropriate indications and in an appropriate manner. In addition, several special medications and treatments before and/or after the procedure might also be useful in reducing the risks associated with it.