Endoscopic Papillary Balloon Dilation and Extraction of Bile Duct Stone

Endoscopic therapy is the first-line treatment for patients with common bile duct stones. Removing bile duct stones by endoscopic retrograde cholangiopancreaticography (ERCP) requires enlarging the papillary opening, either by cutting the biliary sphincter with an endoscopic sphincterotomy or by endoscopic papillary balloon dilation. Dilation has the advantage of sphincter preservation and a lower risk of hemorrhage, but carries an increased risk of post-ERCP pancreatitis. Although popular in Asia, in the Western world this technique is therefore reserved for patients with a major risk of bleeding or difficult anatomy. Here the technique of balloon dilation of the papillary sphincter is demonstrated in a patient with cholangiosepsis and septic coagulopathy. This article is part of an expert video encyclopedia.