Ding J, Li F, Zhu HY, Zhang XW. Endoscopic treatment of difficult extrahepatic bile duct stones, EPBD or EST: An anatomic view. World J Gastrointest Endosc 2015; 7(3): 274-277 [PMID: 25789099 DOI: 10.4253/wjge.v7.i3.274]
Corresponding Author of This Article
Xi-Wen Zhang, MD, Department of bilio-pancreatic Surgery, Ren Ji Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, No. 1630 Dong Fang Rd., Shanghai 200217, China. pipi000914@hotmail.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Minireviews
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastrointest Endosc. Mar 16, 2015; 7(3): 274-277 Published online Mar 16, 2015. doi: 10.4253/wjge.v7.i3.274
Endoscopic treatment of difficult extrahepatic bile duct stones, EPBD or EST: An anatomic view
Jun Ding, Fu Li, Hong-Yi Zhu, Xi-Wen Zhang
Jun Ding, Fu Li, Hong-Yi Zhu, Xi-Wen Zhang, Department of bilio-pancreatic Surgery, Ren Ji Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
Author contributions: All authors contributed to this manuscript.
Conflict-of-interest: We declare that we have no financial and personal relationships with other people or organizations that can inappropriately influence our work, and there is no professional or other personal interest of any nature or kind in any product, service and/or company that could be construed as influencing the position presented in this manuscript.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Xi-Wen Zhang, MD, Department of bilio-pancreatic Surgery, Ren Ji Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, No. 1630 Dong Fang Rd., Shanghai 200217, China. pipi000914@hotmail.com
Telephone: +86-21-58752345 Fax: +86-21-58394262
Received: August 27, 2014 Peer-review started: August 29, 2014 First decision: October 28, 2014 Revised: December 16, 2014 Accepted: January 9, 2015 Article in press: January 12, 2015 Published online: March 16, 2015
Abstract
Large bile duct stone (> 10 mm) or multiple stones (≥ 3) are challenging for endoscopists. Endoscopic sphincterotomy (EST) is a routine therapeutic endoscopic retrograde cholangiopancreatography (ERCP) procedure usually used. It is safe and effective, but severe perforation or massive bleeding are the main causes of mortality. Because of the permanent destroy of Oddi sphincter, the use of EST is still controversial. Endoscopic papillary balloon dilation (EPBD) gives another way to open the sphincter. Less incidence of bleeding, perforation and partly preserving the Oddi sphincter’s function are the main advantages. But high incidence of post-ERCP pancreatitis becomes a predominant problem. According to the anatomical feature of Oddi sphincter, limited EST + EPBD seems a more reasonable procedure. Compared to the former two procedures, it makes the stone extraction process much easier with lower incidences of short-term and long-term complications.
Core tip: This review describes endoscopic sphincterotomy (EST), endoscopic papillary balloon dilation (EPBD) and limited EST + EPBD in the treatment of difficult bile duct stones. We analyze the advantages and disadvantages of these procedures from a unique anatomic view. Limited EST + EPBD may be the most reasonable procedure with the highest successful rate and the lowest incidence of complications.
