ENDOSCOPIC BILIARY LARGE BALLOON DILATION LITHOTRIPSY (“BALLOON LITHOTRIPSY”) FOR DIFFICULT BILE DUCT STONES REMOVAL

Aims:

Endoscopic removal of multiple, large or impacted stones, in which a lithotriptor basket cannot be deployed or is unable to grasp the stone(s), is challenging, and inevitably leads to repeat procedures such as stent insertion and extra or intracorporal lithotripsy. The aim of this study is to evaluate the safety and efficacy of “endoscopic billiary dilation balloon lithotripsy” (EBBD, a novel technique) for difficult stones, which were not amenable to basket or balloon retrieval after papillotomy and papillary large balloon dilation.

Methods:

We retrieved data from 1289 ERCPs from 2 prospective trials performed between 2014 and 2018 dealing with post ERCP pancreatitis prevention. Patients with difficult bile duct stones, in which a balloon dilator up to 18 mm was used to crush or increase the working space parallel to the stones in the common or hepatic duct, were included in the study.

Results:

From the 1289 ERCPs, 258 had difficult stones (> 1 cm, impacted or multiple Stones). EBBD was employed in 46 cases after endoscopic papillotomy and papillary large balloon dilation with failed attempted balloon or basket stone(s) extraction. Failure to clear the bile duct at 1st ERCP occurred in 4 cases (91.3% of success). There was 1 biliary perforation related to EBBD in a patient with a residual cholesterol stone that was sucessfully treated conservatively by stent insertion.

Conclusions:

Endoscopic billiary balloon dilation lithotripsy in order to crush the stones or make working room for baskets or balloons in the bile duct is a safe, effective and a low cost technique for impacted or multiple bile duct stones.