Biliary sphincter balloon dilation; who, when and how?

Biliary sphincter balloon dilation for biliary stone removal was introduced in 1983. In the early 1990s, several groups studied this technique further. The success rate of stone removal is comparable with that of endoscopic sphincterotomy in patients with fewer than three stones that are less then 1 cm in diameter. Fewer complications after balloon dilation than after endoscopic sphincterotomy have been noted in most studies. One study, however, showed a higher incidence of pancreatitis and, in particular, severe pancreatitis. Therefore, there is still some reluctance among endoscopists to promote balloon dilation as a routine first choice treatment. The technique, however, is accepted as the treatment of choice in patients with a bleeding tendency and those in whom the local anatomy is associated with an increased risk of complications with endoscopic sphincterotomy, such as patients with periampullary diverticula or Billroth II gastrectomy.