, Volume 59, Issue 5, pp 902-904
Date: 22 Feb 2014

Endoscopic Papillary Balloon Dilation Versus Sphincterotomy for Removal of Small Common Bile Duct Stones in Young Patients: Unresolved Issues for an Expanding Technique

Endoscopic papillary balloon dilation (EPBD) to assist removal of common bile duct (CBD) stones was introduced as an alternative to endoscopic sphincterotomy (ES) under the theory that by avoiding permanent ablation of the sphincter of Oddi, long-term morbidity may be reduced. After ES, the function of the biliary sphincter is permanently lost, as determined by manometric studies up to 17 years post-sphincterotomy [1]. Moreover, high levels of bacterial colonization with associated deconjugation of hydrophobic bile salts and chronic common hepatic duct inflammation, possibly due to the due to reflux of luminal contents with fibrosis, occurs in patients following ES [2].
Since biliary sphincter function is not affected by EPBD, the incidence of post-procedural CBD stone formation appears to be markedly reduced compared with ES. In a study of 94 patients who had an ES 15 years prior followed by early cholecystectomy for choledocholithiasis, ~11 % developed recurrent CBD stones [3]. Anothe...