Endoscopic balloon sphincteroplasty for extraction of large radiolucent pancreatic duct stones (with videos)

BackgroundAlthough radiopaque pancreatic duct stones can be targeted by extracorporeal shock wave lithotripsy (ESWL) and extracted by ERCP, large and radiolucent stones remain a therapeutic challenge.ObjectiveTo evaluate the technical success and safety of endoscopic balloon sphincter dilation technique (sphincteroplasty) for extraction of large radiolucent pancreatic duct stones.DesignCase series.SettingTertiary referral center.PatientsFour symptomatic patients with large (≥1 cm) radiolucent stones occluding the main pancreatic duct that could not be retrieved by standard endoscopic maneuvers.InterventionsPancreatic sphincterotomy followed by balloon dilation of the pancreatic orifice to aid retrieval of large radiolucent stones occluding the main pancreatic duct.Main Outcome MeasurementsTechnical success and safety of the balloon dilation (sphincteroplasty) technique. Technical success was defined as the ability to achieve pancreatic duct clearance in 1 endoscopic encounter. Complications were assessed according to consensus criteria.ResultsThe procedure was technically successful in all 4 patients. Pancreatic duct clearance was achieved in all 4 patients in 1 endoscopy session with complete symptom relief at 12-month follow-up. Mild post-ERCP pancreatitis developed in 1 patient, and minor bleeding developed in another patient; both were managed conservatively.LimitationSmall number of patients.ConclusionsEndoscopic balloon dilation of the pancreatic orifice after sphincterotomy is a safe technique that facilitates the removal of large radiolucent stones from the main pancreatic duct in 1 endoscopic session. More studies with larger numbers of patients are required before this technique can be adopted routinely as a treatment alternative for patients with large radiolucent pancreatic duct stones.