Efficacy and safety of Endoscopic sphincterotomy combined with balloon dilation for common bile duct stone during Endoscopic retrograde cholangiopancreatography

[Background] Recently, an alternative approach to EST for common bile duct stones (CBDS), referred to as ESBD (EST followed by EPBD) has gained attention. This study aims to evaluate the efficacy and safety of ESBD for CBDs compared to EST alone.
[Methods] We performed a retrospective analysis of patients who underwent ESBD or EST for CBDs between January 2017 and February 2025 at Tonan Hospital. The exclusion criteria were as follows: EPLBD (balloon dilation >10mm), previous EST or EPBD. Outcomes were measured based on successful removal rate and complication rate.
[Result] A total of 196 patients were divided into two groups (ESBD n=101, EST n=97). Although the small incision rate was significantly higher in EST group (P<0.001), the stone clearance rates were very similar in ESBD and EST groups (98% and 97.9%, respectively). ESBD group had a significantly higher rate of procedures performed by trainees compared to EST group (35.6% vs 17.5%, P<0.01). Overall complications were slightly lower (5% vs 7.2%) in ESBD group, with a similar incidence of pancreatitis (2% vs 2.1%). There were fewer cases of delayed bleeding (1% vs 3.1%) in ESBD group. No differences in the incidence of complication were observed regardless of the endoscopist`s experience.
[Conclusion] ESBD for CBDs is a feasible and safe similar to EST, with some advantages in terms of delayed bleeding and trainee involvement.