Endoscopic large-diameter balloon dilation after fistulotomy for the removal of bile duct stones in a difficult cannulation.
BACKGROUND
When standard methods of biliary cannulation fail, needle-knife fistulotomy may be used. However, large stones cannot be easily extracted through the necessarily smaller opening made when using the fistulotomy technique.


OBJECTIVE
We report the efficacy and safety of endoscopic large-diameter balloon dilation after fistulotomy for the removal of bile duct stones in patients in whom cannulation is difficult.


METHODS
A case series.


METHODS
A tertiary referral center.


METHODS
Six patients (6 of 115, 5.2%) with bile duct stones in whom cannulation by the conventional method had failed underwent fistulotomy and large-diameter (12-15 mm) balloon dilation through the fistulotomy tract.


METHODS
Successful biliary cannulation, outcome of therapy, and post-ERCP complications including pancreatitis were recorded.


RESULTS
Biliary cannulation was successful in 6 of 6 patients (100%) with fistulotomy. After endoscopic large-diameter balloon dilation of the fistulotomy tract, stone extraction was successfully performed in 6 of 6 patients. None of the patients developed post-ERCP pancreatitis. One of the 6 patients had minor delayed bleeding, which stopped spontaneously.


CONCLUSIONS
A small case series, retrospective design, and no control group.


CONCLUSIONS
Endoscopic large-diameter balloon dilation through the fistulotomy tract may be a feasible and safe alternative method for the removal of bile duct stones in patients in whom cannulation is difficult.
Park
Seon-Young
SY
Department of Internal Medicine, Division of Gastroenterology, Chonnam National University Medical School, Gwangju, South Korea.
Park
Chang-Hwan
CH
Yoon
Kyoung-Won
KW
Cho
Sung-Bum
SB
Lee
Wan-Sik
WS
Joo
Young-Eun
YE
Kim
Hyun-Soo
HS
Choi
Sung-Kyu
SK
Rew
Jong-Sun
JS