Open AccessEndoscopic treatment of difficult extrahepatic bile duct stones, EPBD or EST: An anatomic view
Author(s) -
Jun Ding,
Fu Li,
Hongyi Zhu,
Xiwen Zhang
Publication year - 2015
Publication title -
world journal of gastrointestinal endoscopy
Language(s) - English
Resource type - Journals
ISSN - 1948-5190
DOI - 10.4253/wjge.v7.i3.274
Subject(s) - medicine , endoscopic retrograde cholangiopancreatography , sphincter of oddi , perforation , bile duct , pancreatitis , sphincter , surgery , balloon dilatation , balloon dilation , radiology , balloon , punching , materials science , metallurgy
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.