ENDOSCOPIC DILATATION OF THE BILIARY SPHINCTER FOR REMOVAL OF BILE-DUCT STONES - AN OVERVIEW OF CURRENT INDICATIONS AND LIMITATIONS

Endoscopic balloon dilatation (EBD) of the biliary sphincter may be an alternative to endoscopic sphincterotomy (EST) for removal of bile du ct stones. After EBD of the biliary sphincter to a diameter of 8 mm, s tones are removed according to standard guidelines. In the event that stone removal fails after EBD, an additional EST is performed. The ove rall success rate of stone removal after EBD (90%) is comparable to th at of EST. After EBD, an additional EST and mechanical lithotripsy are required in 10% and 30% of patients, respectively. In patients with b ile duct stones < 10 mm and a stone number less than or equal to 3, EB D is nearly always successful without the need for additional EST or m echanical lithotripsy. Pancreatitis post-EBD occurs at a rate of 5-7%, which is not significantly different from that after EST. Significant bleeding post-EBD has not been observed in over 400 patients undergoi ng EBD. EBD is a valuable alternative to EST, especially in patients w ith smaller bile duct stones and in patients with haemostatic disorder s.