Division of Gastroenterology, Department of Internal Medicine, Yonsei Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea.
Gut Liver. 2011 Mar;5(1):1-14. doi: 10.5009/gnl.2011.5.1.1. Epub 2011 Mar 16.
Endoscopic papillary balloon dilation (EPBD) is an alternative method of endoscopic sphincterotomy (EST). Although concerns regarding post-procedure pancreatitis have been expressed, EPBD has come to be recognized as an effective and safe method for stone removal in specific cases. To analyze the proper indications, ideal methods, complications, and long-term follow-up results for EPBD, we reviewed articles about EPBD located through a search of the PubMed data base. We analyzed the ballooning methods, indications, results and complications of EPBD among the articles found and compared the results with those of EST. We considered the authors' own clinical experience and knowledge in developing recommendations for EPBD. EPBD showed similar efficacy and safety for the removal of choledocholithiasis to that of EST. Although large or multiple stones were difficult to remove by EPBD, it was safer and easier to apply in patients with coagulopathy or abnormal anatomy. To prevent severe pancreatitis, excessive ballooning and impractical cannulation should be avoided, and precut sphincterotomy or adjuvant prophylaxis should be considered. Due to its preservation of the sphincter of Oddi, EPBD is expected to have fewer long-term complications, such as stone recurrence, cholangitis and cholecystitis. In conclusion, EPBD appears to be safe and effective for the treatment of choledocholithiasis with proper selection of ballooning methods and patients.
内镜下乳头球囊扩张术（EPBD）是内镜下括约肌切开术（EST）的替代方法。尽管人们对术后胰腺炎表示担忧，但 EPBD 已被认为是在特定情况下去除结石的有效且安全的方法。为了分析 EPBD 的适当适应证、理想方法、并发症和长期随访结果，我们通过检索 PubMed 数据库检索了关于 EPBD 的文章。我们分析了文章中 EPBD 的球囊扩张方法、适应证、结果和并发症，并将结果与 EST 进行了比较。我们考虑了作者自己的临床经验和知识，提出了 EPBD 的建议。EPBD 在去除胆总管结石方面与 EST 具有相似的疗效和安全性。尽管大结石或多发结石难以通过 EPBD 取出，但在凝血功能障碍或解剖异常的患者中，EPBD 更安全、更容易应用。为了预防严重胰腺炎，应避免过度球囊扩张和不切实际的插管，并且可以考虑行预切开括约肌切开术或辅助预防。由于其对 Oddi 括约肌的保留，EPBD 预计在长期并发症方面，如结石复发、胆管炎和胆囊炎的发生风险较低。总之，在适当选择球囊扩张方法和患者的情况下，EPBD 似乎是一种安全有效的治疗胆总管结石的方法。
