Risk management for endoscopic treatment for common bile duct stones: Endoscopic sphincterotomy and endoscopic papillary balloon dilation

Currently, endoscopic treatment for common bile duct stones is widely performed all over the world. Endoscopic sphincterotomy (EST) and endoscopic papillary balloon dilation (EPBD) are representative treatments of this modality in Japan. Both of them are much more convenient and much less invasive than surgical operation. These two procedures are also recognized as being relatively safe, but it is also a fact that serious complications may still occur at a certain rate. Bleeding, pancreatitis and duodenal perforation can occur in association with EST, and pancreatitis is the most important issue related to EPBD. To reduce the risk, these procedures should be performed only under the appropriate indications and in an appropriate manner. In addition, several special medications and treatments before and/or after the procedure might also be useful in reducing the risks associated with it.