Endoscopic partial sphincterotomy coupled with large balloon papilla dilation – Single stage approach for management of extra-hepatic bile ducts macro-lithiasis **

Endoscopic papillary balloon dilation (EPBD) was introduced in the 80 s as an alternative for treatment of biliary lithiasis in order to minimize complications related to biliary endoscopic sphincterotomy (ES) and to preserve sphincter mechanism. However it could not gain wide acceptance because of high incidence of post procedural pancreatitis compared to ES alone. In 2003, endoscopic large balloon papillary dilation (ELPBD) coupled with ES, has been proposed as an alternative to lithotripsy for treatment of giant or difficult calculi of the common bile duct. Since then, several studies have evaluated the efficacy of such approach, however in the absence of clear instructions about indications, technique's standardization, morbidity rate and long-term results this procedure has not yet gained wide use. In this report we describe our technique of partial endoscopic sphincterotomy plus large papillary balloon dilation in the treatment of common bile duct and cystic duct macro-lithiasis. According to our clinical experience, we would like to focus on the technical points that have to be respected in order to reduce procedure's complications and to achieve successful clinical resultsWe conclude that endoscopic partial sphincterotomy plus large papillary balloon dilation seems a promising, effective and safe approach to treat giant extrahepatic biliary calculi, if performed after correct patient selection and under established guidelines.