Skip to main content
Log in

Post-sphincterotomy Transampullary Balloon Dilation Is a Safe and Effective Technique

  • Original Article
  • Published:
Digestive Diseases and Sciences Aims and scope Submit manuscript

Abstract

Purpose To evaluate the safety and efficacy of performing ampullary balloon dilation (ABD) following endoscopic sphincterotomy (ES). Methods Retrospective review of patients that underwent ABD at Thomas Jefferson University from 2000 to 2007. In all cases, dilation was performed with Hurricane® RX hydrostatic balloons (Boston Scientific, Natick MA) or CRETM esophageal dilating balloons (Boston Scientific, Natick MA). Results ABD following ES was performed in 69 patients. The procedure was performed for choledocholithiasis in 58%, abnormal imaging in 26%, and abnormal liver enzymes in 23% of patients. ABD following ES was 86% successful in achieving the intended therapeutic goal of the procedure. Pancreatitis (2.9%) post endoscopic retrograde cholangiopancreatography (ERCP) occurred in two individuals, with one case of hemorrhage (1.5%) and one perforation (1.5%). Conclusion ABD following ES is a safe and effective alternative to ES alone, particularly for the extraction of large common bile duct (CBD) stones.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Staritz M, Ewe K, Meyer zum Buschenfelde KH (1983) Endoscopic papillary dilation (EPD) for the treatment of common bile duct stones and papillary stenosis. Endoscopy 15:197–198

    Article  PubMed  Google Scholar 

  2. Costamagna G, Tringali A, Shah SK, Mutiganani M, Zuccala G, Perri V (2002) Long-term follow-up of patients after endoscopic sphincterotomy for choledocholithiasis, and risk factors for recurrence. Endoscopy 34:273–279. doi:10.1055/s-2002-23632

    Article  PubMed  CAS  Google Scholar 

  3. Bergman JJ, van der Mey S, Rauws EA, Tijssen JG, Gouma DJ, Tytgat GN et al (1996) Long-term follow-up after endoscopic sphincterotomy for bile duct stones in patients younger than 60 years of age. Gastrointest Endosc 44:643–649. doi:10.1016/S0016-5107(96)70045-7

    Article  PubMed  CAS  Google Scholar 

  4. Hawes RH, Cotton PB, Vallon AG (1990) Follow-up 6 to 11 years after duodenoscopic sphincterotomy for stones in patients with prior cholecystectomy. Gastroenterology 98:1008–1012

    PubMed  CAS  Google Scholar 

  5. Kawabe T, Komatsu Y, Tada M, Toda N, Ohashi M, Shiratori Y et al (1996) Endoscopic papillary balloon dilation in cirrhotic patients: removal of common bile duct stones without sphincterotomy. Endoscopy 28:694–698

    Article  PubMed  CAS  Google Scholar 

  6. Park DH, Kim MH, Lee SK, Lee SS, Choi JS, Song MH et al (2004) Endoscopic sphincterotomy vs. endoscopic papillary balloon dilation for choledocholithiasis in patients with liver cirrhosis and coagulopathy. Gastrointest Endosc 60:180–185. doi:10.1016/S0016-5107(04)01554-8

    Article  PubMed  Google Scholar 

  7. DiSario JA, Freeman ML, Bjorkman DJ et al (2004) Endoscopic balloon dilation compared with sphincterotomy for extraction of bile duct stones. Gastroenterology 127:1291–1299. doi:10.1053/j.gastro.2004.07.017

    Article  PubMed  Google Scholar 

  8. Minami A, Nakatsu T, Uchida N et al (1995) Papillary dilation vs sphincterotomy in endoscopic removal of bile duct stones. Arandomized trial with manometric function. Dig Dis Sci 40:2550–2554. doi:10.1007/BF02220440

    Article  PubMed  CAS  Google Scholar 

  9. Bergman JJ, Rauws EA, Fockens P et al (1997) Randomized trial of endoscopic balloon dilation versus endoscopic sphincterotomy for removal of bile duct stones. Lancet 349:1124–1129. doi:10.1016/S0140-6736(96)11026-6

    Article  PubMed  CAS  Google Scholar 

  10. Ochi Y, Mukawa K, Kiyosawa K et al (1999) Comparing the treatment outcomes of endoscopic papillary dilation and endoscopic sphincterotomy for removal of bile duct stones. J Gastroenterol Hepatol 14:90–96. doi:10.1046/j.1440-1746.1999.01798.x

    Article  PubMed  CAS  Google Scholar 

  11. Arnold JC, Benz C, Martin WR et al (2001) Endoscopic papillary balloon dilation vs. sphincterotomy for removal of common bile duct stones: a prospective randomized pilot study. Endoscopy 33:563–567. doi:10.1055/s-2001-15307

    Article  PubMed  CAS  Google Scholar 

  12. Yasuda I, Tomita E, Enya M et al (2001) Can endoscopic papillary balloon dilation really preserve sphincter of Oddi function? Gut 49:686–691. doi:10.1136/gut.49.5.686

    Article  PubMed  CAS  Google Scholar 

  13. Natsui M, Narisawa R, Motoyama H et al (2002) What is an appropriate indication for endoscopic papillary balloon dilation? Eur J Gastroenterol Hepatol 14:635–640. doi:10.1097/00042737-200206000-00008

    Article  PubMed  Google Scholar 

  14. Fujita N, Maguchi H, Komatsu Y et al (2003) Endoscopic sphincterotomy and endoscopic papillary balloon dilation for bile duct stones: a prospective randomized controlled multicenter trial. Gastrointest Endosc 57:151–155. doi:10.1067/mge.2003.56

    Article  PubMed  Google Scholar 

  15. Vlavianos P, Chopra K, Mandalia S et al (2003) Endoscopic balloon dilation versus endoscopic sphincterotomy for the removal of bile duct stones: a prospective randomised trial. Gut 52:1165–1169. doi:10.1136/gut.52.8.1165

    Article  PubMed  CAS  Google Scholar 

  16. Baron TH, Harewood GC (2004) Endoscopic balloon dilation of the biliary sphincter compared to endoscopic biliary sphincterotomy for removal of common bile duct stones during ERCP: a metaanalysis of randomized, controlled trials. Am J Gastroenterol 99:1455–1460. doi:10.1111/j.1572-0241.2004.30151.x

    Article  PubMed  Google Scholar 

  17. Weinberg BM, Shindy W, Lo S (2006) Endoscopic balloon sphincter dilation (sphincteroplasty) versus sphincterotomy for common bile duct stones. Cochrane Database Syst Rev 4:CD004890

    PubMed  Google Scholar 

  18. Mac Mathuna P, Siegenberg D, Gibbons D et al (1996) The acute and long-term effect of balloon sphincteroplasty on papillary structure in pigs. Gastrointest Endosc 44:65–655. doi:10.1016/S0016-5107(96)70046-9

    Article  Google Scholar 

  19. Ersoz G, Tekesin O, Ozutemiz AO et al (2003) Biliary sphincterotomy plus dilation with a large balloon for bile duct stones that are difficult to extract. Gastrointest Endosc 57:156–159. doi:10.1067/mge.2003.52

    Article  PubMed  Google Scholar 

  20. Maydeo A, Bhandari S (2007) Balloon sphincteroplasty for removing difficult bile duct stones. Endoscopy 39:958–961. doi:10.1055/s-2007-966784

    Article  PubMed  CAS  Google Scholar 

  21. Bang S, Kim MH, Park JY et al (2006) Endoscopic papillary balloon dilation with large balloon after limited sphincterotomy for retrieval of choledocholithiasis. Yonsei Med J 27:805–810

    Article  Google Scholar 

  22. Minami A, Hirose S, Nomoto T et al (2007) Small sphincterotomy combined with papillary dilation with large balloon permits retrieval of large stones without mechanical lithotripsy. World J Gastroenterol 13:2179–2182

    PubMed  Google Scholar 

  23. Heo JH, Kang DH, Jung HJ et al (2007) Endoscopic sphincterotomy plus large-balloon dilation versus endoscopic sphincterotomy for removal of bile-duct stones. Gastrointest Endosc 66:720–726. doi:10.1016/j.gie.2007.02.033

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Rahul A. Nathwani.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Kowalski, T., Nathwani, R.A., Assis, D. et al. Post-sphincterotomy Transampullary Balloon Dilation Is a Safe and Effective Technique. Dig Dis Sci 54, 670–674 (2009). https://doi.org/10.1007/s10620-008-0376-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10620-008-0376-x

Keywords

Navigation