title: Endoscopic treatment of difficult extrahepatic bile duct stones, EPBD or EST: An anatomic view.
abstract: Large bile duct stone (> 10 mm) or multiple stones (≥ 3) are challenging for endoscopists. Endoscopic sphincterotomy (EST) is a routine therapeutic endoscopic retrograde cholangiopancreatography (ERCP) procedure usually used. It is safe and effective, but severe perforation or massive bleeding are the main causes of mortality. Because of the permanent destroy of Oddi sphincter, the use of EST is still controversial. Endoscopic papillary balloon dilation (EPBD) gives another way to open the sphincter. Less incidence of bleeding, perforation and partly preserving the Oddi sphincter's function are the main advantages. But high incidence of post-ERCP pancreatitis becomes a predominant problem. According to the anatomical feature of Oddi sphincter, limited EST + EPBD seems a more reasonable procedure. Compared to the former two procedures, it makes the stone extraction process much easier with lower incidences of short-term and long-term complications.
authors: Jun Ding, Fu Li, Hong-Yi Zhu, Xi-Wen Zhang, Department of bilio-pancreatic Surgery, Ren Ji Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China.
authors: Jun
authors: J
authors: Ding
authors: Jun Ding, Fu Li, Hong-Yi Zhu, Xi-Wen Zhang, Department of bilio-pancreatic Surgery, Ren Ji Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China.
authors: Fu
authors: F
authors: Li
authors: Jun Ding, Fu Li, Hong-Yi Zhu, Xi-Wen Zhang, Department of bilio-pancreatic Surgery, Ren Ji Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China.
authors: Hong-Yi
authors: HY
authors: Zhu
authors: Jun Ding, Fu Li, Hong-Yi Zhu, Xi-Wen Zhang, Department of bilio-pancreatic Surgery, Ren Ji Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China.
authors: Xi-Wen
authors: XW
authors: Zhang
keywords: Common bile duct stone; Endoscopic papillary balloon dilation; Endoscopic retrograde cholangiopancreatography; Endoscopic sphincterotomy