New large-diameter balloon-equipped sphincterotome for removal of large bile duct stones (with videos)

Background

Recently, endoscopic biliary sphincterotomy (EBS) followed by large-diameter balloon dilation has been used for the removal of large bile duct stones. A limitation is the need for 2 accessories: a sphincterotome and a dilating balloon.

Objective

To evaluate a new device, a combination of a large-diameter dilating balloon and sphincterotome (LDDBS).

Design

Retrospective study.

Setting

University hospital.

Patients

Eighteen patients with large bile duct stones.

Interventions

After performing EBS by using the LDDBS, the catheter was then advanced into the bile duct and balloon dilation was performed by gradual inflation with diluted contrast medium under endoscopic and fluoroscopic guidance until it reached a diameter adequate to allow stone removal.

Main Outcome Measurements

Feasibility and efficacy of stone removal by using an LDDBS.

Results

Technical success of large-diameter balloon dilation after EBS was achieved in all cases. Bile duct clearance was accomplished in 94% (17/18) of cases in the first session. Bile duct clearance was eventually completed in all patients. Mechanical lithotripsy was required in 4 patients (22%). There were no major intraprocedural or postprocedural complications.

Limitations

Single-institution study, small sample size.

Conclusions

The prototype LDDBS is safe and effective to facilitate the removal of large bile duct stones by using one accessory.

Abbreviations: EBS, endoscopic biliary sphincterotomy, ESLDBD, endoscopic sphincterotomy plus large-diameter balloon dilation, LDDBS, large-diameter dilating balloon and sphincterotome