Endoscopic papillary balloon dilation: Revival of the old technique

Table 5 Tips for avoiding severe complications of endoscopic papillary balloon dilation

EPBD

EPLBD

1. A balloon smaller than the diameter of the CBD is recommended to reduce damage to the SO and pancreatic orifice. 2. Graded balloon inflation may significantly reduce the incidence of post-EPBD pancreatitis. 3. If the balloon’s waist remains after 2–3 s at maximal balloon inflation, balloon dilation must be stopped immediately.

1. Maximal inflated diameter of balloon should not exceed the CBD diameter. 2. A small extent of EST followed by large balloon dilation may be recommended, rather than large balloon dilation without EST. 3. The balloon should be inflated gradually to avoid perforation and bleeding. 4. If the balloon’s waist remains at 80% of the maximum inflation capacity, balloon dilation must be stopped immediately and change to alternative procedures, such as EST and ML. 5. Close monitoring must be necessary after EPLBD to detect the delayed complications, such as perforation and delayed bleeding.

SO: Sphincter of Oddi; EPBD: Endoscopic papillary balloon dilation; CBD: Common bile duct; EST: Endoscopic biliary sphincterotomy; ML: Mechanical lithotripsy; EPLBD: Endoscopic papillary large balloon dilation.