Endoscopic Sphincterotomy Analysis

Endoscopic retrograde cholangiopancreatography (ERCP) has become one of the most important techniques for the diagnosis and treatment of choledocholithiasis. Endoscopic balloon dilatation (EBD) and endoscopic sphincterotomy (ES) are the most important endoscopic techniques used for retrieval of common bile duct stones (1) and ES is the most commonly used method as a standard technique. (2) Despite the relative safety of ES the overall complication rate is about 10%. (3) The short-term risk of pancreatitis, bleeding, perforation, and death, along with the potential long-term complications of papillary stenosis and the danger of bacterial contamination of biliary system are important concerns. (4) Endoscopic balloon dilation (EBD) was first
(7) Rate of pancreatitis in case series evaluating (EBD) for common bile duct stone removal range from 0% to 7% (8) compared with reported rate of 0% to 39% in series evaluating ES for stone removal. (3) On the other hand endoscopic balloon dilation appears to have lower rates of bleeding and perforation. While endoscopic sphincterotomy involves cutting and carries bleeding rates of 2% to 5% (3), endoscopic balloon dilation theoretically preserves the biliary sphincter with reportedly no bleeding. (9) Consequently, (EBD) has been shown to be safe even in patients with coagulopathies compared to (ES). The risk of perforation also appears to be lower in endoscopic balloon dilation with reported rates in case series of 0% to 1% as compared with 1% to 2% in endoscopic sphincterotomy series. (8) Since endoscopic balloon dilation has been demonstrated to preserve the sphincter of Oddi, the potential long-term consequences of endoscopic sphincterotomy are theoretically avoided. (10) However, (EBD) has several disadvantages such as more frequent requirement of mechanical lithotripsy and more sessions to achieve bile duct