Loading...
After biliary sphincterotomy during endoscopic retrograde cholangiopancreatography, about 95% of bile-duct stones can be removed with balloon-and-basket extraction supplemented with mechanical lithotripsy. However, the procedure can fail if the sphincterotomy is small (for anatomic reasons, such as diverticula) and the distal bile duct is narrow relative to the stone size. An alternative technique is to perform small sphincterotomy followed by dilation of the biliary orifice with a 20-mm balloon. Stones can then be removed via balloon or basket without lithotripsy.
To evaluate the safety and efficacy of this technique, investigators in Japan enrolled 88 consecutive patients with large bile-duct stones (mean stone size, 14 mm; mean number of …