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Eduardo Tavio-Hernandez [] and Enrique Vazquez-Sequeiros [] and Enrique Rodriguez-Santiago [] and Juan Angel Gonzalez-Martin [] and Jose Ramón Foruny-Olcina [] and Vicente Benita-Leon [] and Victor Defarges-Pons [] and Daniel Boixeda-Miquel [] and Agustin Albillos-Martínez [] and []

Academic Editor: Firas H. Al-Kawas

Endoscopy Unit, Gastroenterology and Hepatology Department, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain, hrc.es

Received Feb 7, 2017; Revised May 15, 2017; Accepted May 23, 2017

This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

1. Introduction

Treatment of common bile duct (CBD) stones is, at present time, the most frequent indication to perform endoscopic retrograde cholangiopancreatography (ERCP) in Western countries [1]. For this purpose, we have a variety of endoscopic techniques of proven efficacy. Among them, the most frequently used are endoscopic sphincterotomy (EST) and mechanical lithotripsy (ML) that facilitate stone removal with a Fogarty balloon or a Dormia basket [2].

Endoscopic papillary large balloon dilatation (EPLBD) has emerged in recent years as an alternative or complement to EST, which was classically considered the standard therapy [3]. EPLBD was initially developed under the hypothesis that it could potentially be less traumatic than EST to the major papilla, and therefore, it could be associated with fewer adverse events [3]. Initial studies showed that EPLBD was indeed associated with less bleeding but an increased risk of acute pancreatitis [4, 5].

However, EPLBD in patients with prior EST has been demonstrated in several meta-analyses [6–10], to have a safety profile and effectiveness similar to EST, and may be even more cost-effective, by reducing the number of ERCPs required to completely clean the CBD in patients with multiple or large stones [8, 11–13]. Furthermore, some recent studies have suggested that EPLBD may be equally effective even in patients with no EST [14–16]. For these reasons, EPLBD has become accepted in clinical practice as a solid alternative to EST when treating large CBD stones [2, 17], and some authors may even consider EPLBD as the first option in those patients [8, 12].

Although there are some data in the literature [18] regarding potential predictors of therapeutic success and development of adverse events after...

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