ENDOSCOPIC PAPILLARY AND BILIARY LARGE BALLOON DILATION IS SAFE AND EFFECTIVE FOR DIFFICULT STONES REMOVAL IN PATIENTS WITH NONDILATED OR TAPERED DISTAL BILE DUCT

Aims:

According to guidelines, papillary/biliary balloon dilation (PBBD) should not exceed the maximum diameter of the distal bile duct and should not be performed in cases of nondilated distal bile duct. So, the use of papillary/biliary balloon dilation is contraindicated in patients with nondilated or tapered distal bile duct, in whom there is disproportion between the size of the stone and the distal bile duct. In this series, we analyze the feasibility of balloon dilation for difficult stones (> 1 cm, impacted or multiple) in patients with a narrow distal bile duct.

Methods:

Data from 1289 ERCPs from two prospective studies performed between 2014 and 2018 for post ERCP pancreatitis prevention were retrieved. 258 cases had difficult stones and 182 underwent papillary/biliary balloon dilation up to 18 mm after endoscopic papillotomy. The balloon was always inflated accross the papilla up to 18 mm in order to obliterate its waist, regardless the presence of a distal situated stone. Primary outcomes were clearance rate at 1st ERCP and complications.

Results:

Of the 182 patients (120F; mean age 60 yr.), who underwent PBBD for difficult stones, 111 (61%) had non-dilated or tapered distal bile duct. Clearance rate at first ERCP was comparable among patients with dilated distal duct (67 of 71; 94%) and nondilated distal duct (102 of 111; 92%). Procedures were faster in patients with dilated distal duct (mean 17 vs. 24 min, p < 0.005). Complications were comparable in both groups (7.04% VS 7.2%).

Conclusions:

PBBD for giant, multiple or impacted stones is feasible and safe in patients with nondilated or, even narrow, distal bile duct.