Aim: To assess the efficacy and safety of hydrostatic dilatation with large balloons for the treatment of choledocolithiasis in patients with difficult or risky extraction due to stone characteristics or peripapillary anatomy.
Design: Prospective.
Patients: This study included 22 patients in whom a hydrostatic dilatation of the papilla with large balloons was performed between June 2005 and April 2006. Patients had multiple large stones, tapered distal common bile duct, peri-/intradiverticular papilla, previous sphincterotomy, or Billroth-II surgery. Esophageal, pyloric and colonic CRE dilatation balloons with diameters ranging from 12 to 20 mm (Boston Scientific Corporation) were used.
Results: Stone removal was achieved in a single session in all patients (100%). Most procedures (73%) did not require an extended exploration time. There were no complications. Hyperamilasemia was detected in 18% of patients.
Conclusions: Hydrostatic papillary dilatation with large balloons is a simple, effective, and safe technique for the removal of difficult stones located in the distal common bile duct. It does not add to exploration time, nor increases complications, and reduces the need for lithotripsy. Further studies are needed to define the usefulness of this technique.