Published online Jul 14, 2016. doi: 10.3748/wjg.v22.i26.5909
Peer-review started: February 13, 2016
First decision: March 21, 2016
Revised: March 23, 2016
Accepted: April 7, 2016
Article in press: April 7, 2016
Published online: July 14, 2016
Core tip: Some recent studies suggest that Endoscopic papillary balloon dilatation (EPBD) itself does not increase post-endoscopic retrograde cholangio-pancreatography (ERCP) pancreatitis (PEP) incidence. Theoretically, endoscopic papillary large-balloon dilatation (EPLBD) can damage the papilla more than EPBD does, but even direct EPLBD without preceding sphincterotomy does not increase PEP rate. An explanation for this paradox is that procedures following EPBD, but not EPBD itself, induce PEP. Since the EPBD stress is limited around the papilla, a prophylactic pancreatic stent could protect against the damage related to EPBD. EPBD has many advantages that endoscopic sphincterotomy does not. Therefore, it is time to re-evaluate the risks and efficacy of EPBD, and to utilize it suitably instead of shelving it.