Endoscopic treatment of difficult extrahepatic bile duct stones, EPBD or EST: An anatomic view

World Journal of Gastrointestinal Endoscopy
Jun DingXi-Wen Zhang

Abstract

Large bile duct stone (> 10 mm) or multiple stones (≥ 3) are challenging for endoscopists. Endoscopic sphincterotomy (EST) is a routine therapeutic endoscopic retrograde cholangiopancreatography (ERCP) procedure usually used. It is safe and effective, but severe perforation or massive bleeding are the main causes of mortality. Because of the permanent destroy of Oddi sphincter, the use of EST is still controversial. Endoscopic papillary balloon dilation (EPBD) gives another way to open the sphincter. Less incidence of bleeding, perforation and partly preserving the Oddi sphincter's function are the main advantages. But high incidence of post-ERCP pancreatitis becomes a predominant problem. According to the anatomical feature of Oddi sphincter, limited EST + EPBD seems a more reasonable procedure. Compared to the former two procedures, it makes the stone extraction process much easier with lower incidences of short-term and long-term complications.

Citations

Feb 13, 2020·Pancreas·Carolina Ogawa MatsubayashiEduardo Guimarães Hourneaux de Moura
Jul 29, 2020·Saudi Journal of Gastroenterology : Official Journal of the Saudi Gastroenterology Association·Shigeto IshiiHiroyuki Isayama
Aug 11, 2020·World Journal of Gastroenterology : WJG·Bin LiuYu-Liang Li

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