ASGE Postgraduate Course at ACG 2022: Expanding the Scope of Fundamental and Advanced Endoscopy | October 2022-9_Chahal

9_Chahal_Clear the Path PapillaryBalloonDilation

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In this document, Dr. Prabhleen Chahal discusses the use of papillary dilation for the treatment of bile duct stones. Choledocholithiasis, the presence of stones in the common bile duct, is a common condition seen in patients undergoing cholecystectomy. Retrieval basket and balloon techniques combined with sphincterotomy are effective in managing 85-90% of CBD stones. However, for larger stones, endoscopic papillary large balloon dilation (EPLBD) has been shown to be successful in clearing stones ranging from 15-28mm.<br /><br />EPLBD involves inflating a balloon in the distal CBD after sphincterotomy. Practical tips for EPLBD include using a balloon size that matches the size of the distal CBD, graded inflation until the waist is gone, and avoiding inflating the balloon next to the stone. Several randomized controlled trials have demonstrated the efficacy of EPLBD in achieving overall stone clearance compared to sphincterotomy alone.<br /><br />The combination of EPLBD and sphincterotomy has shown higher rates of overall clearance compared to sphincterotomy alone. EPLBD also reduces the need for mechanical lithotripsy and has comparable adverse event rates to sphincterotomy alone. Studies have shown clearance rates ranging from 89% to 96.9% with EPLBD.<br /><br />Cholangioscopy is another option for stone removal but is more expensive and has a learning curve. It requires elaborate setup and has a larger carbon footprint. On the other hand, EPLBD is a more cost-effective option.<br /><br />In summary, papillary dilation with large balloon dilation after sphincterotomy is a recommended option for patients with large bile duct stones. It provides an effective and less expensive alternative to cholangioscopy. The adoption and maintenance cost of EPLBD is also lower compared to cholangioscopy.

Keywords

papillary dilation

bile duct stones

choledocholithiasis

retrieval basket

balloon techniques

sphincterotomy

endoscopic papillary large balloon dilation

EPLBD

stone clearance

cholangioscopy