Whether or Not to Cut When Performing Endoscopic Papillary Balloon Dilation

Although endoscopic papillary balloon dilation (EPBD) is widely performed after endoscopic biliary sphincterotomy (ES) to assist in the removal of large bile duct stones, the role of performing EPBD in the absence of sphincterotomy is debated. Published results regarding this technique are conflicting, some showing good outcomes and an acceptable safety profile, while others show a high rate of post–endoscopic retrograde cholangiopancreatography pancreatitis (PEP) and even deaths associated with EPBD in the absence of ES.

In a recent prospective trial, investigators in Korea randomized 200 patients with large (≥10 mm) common bile duct stones in dilated bile ducts (≥12 mm) to undergo EPBD with or without ES. They did not use protease inhibito…