Endoscopic papillary large balloon dilation for the removal of bile duct stones

Table 10 Recommendations for successful endoscopic papillary large balloon dilation

1 EPLBD with large, especially full-incision EST should be avoided

2 EPLBD with limited EST is recommended to be performed, even before attempting trials of a standard technique with large EST, when the stone is seen to be too large on cholangiogram

3 EPLBD without EST may be useful in some patients with coagulopathy, periampullary diverticulum, or surgically altered anatomy

4 In patients with obvious distal bile duct strictures, EPBLD should be avoided. If there is a suspicion of strictures, using the pulling method of a large inflated retrieval balloon through the site is recommended to confirm an existence

5 The intended maximal target diameter of the balloon should be determined based on the diameter of the largest stones, but should not exceed the diameter of the distal bile duct

6 The balloon should always be inflated gradually, starting from a smaller diameter step of the balloon than the intended maximal target diameter

7 Further balloon inflation must be ceased, if the central waist of the balloon does not disappear or the patient indicates severe pain during balloon inflation at any step

EST: Endoscopic sphincterotomy; EPLBD: Endoscopic papillary large balloon dilation.