Biliary sphincter balloon dilation: Who, when and how?

Biliary sphincter balloon dilation for biliary stone removal was introduced in 1983. In the early 1990s, several groups studied this technique further . The success rate of stone removal is comparable with that of endoscopic s phincterotomy in patients with fewer than three stones that are less then 1 cm in diameter. Fewer complications after balloon dilation than after endo scopic sphincterotomy have been noted in mast studies. One study, however, showed a higher incidence of pancreatitis and, in particular, severe pancre atitis. Therefore, there is still some reluctance among endoscopists to pro mote balloon dilation as a routine first choice treatment. The technique, h owever, is accepted as the treatment of choice in patients with a bleeding tendency and those in whom the local anatomy is associated with an increase d risk of complications with endoscopic sphincterotomy, such as patients wi th periampullary diverticula or Billroth II gastrectomy.