Jjghm. Bergman et al., ENDOSCOPIC DILATATION OF THE BILIARY SPHINCTER FOR REMOVAL OF BILE-DUCT STONES - AN OVERVIEW OF CURRENT INDICATIONS AND LIMITATIONS, Scandinavian journal of gastroenterology, 33, 1998, pp. 59-65
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.