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Korean J Pancreas Biliary Tract > Volume 4(2):1999 > Article
The Korean Journal of Pancreas and Biliary Tract 1999;4(2):79-84.
내시경적 담도결석 제거에서 유두부 절개술의 역할
한양대학교 의과대학 내과학교실
EST versus Balloon Plasty
Ho Soon Choi
Department of Internal Medicine, Research Institute of Digestive Disease, Hanyang University College of Medicine, Seoul, Korea
Corresponding author:  Ho Soon Choi, Tel: 2290-8379 , Fax: 2298-9183 , 
EST is a well accepted and well documented treatment modality for the removal of bile duct stone, whereas experience with EPBD is relatively limited, and the risk of pancreatitis of EPBD remain unclear. Therefore the choice between EST and EPBD for the removal of bile duct stone is currently not an issue in most patients. The choice between EST and EPBD depends on the following factors; first, the relative success rate of the two procedures in allowing stone removal; secondly, the risk factors present for any post-ERCP complication (both short-term and long-term) and their relative magnitude; thirdly, the relative severity of the different possible complications; and fourthly, the influence of the expertise of the endoscopist on these different factors. The success rate of stone removal after EST and EPBD is dependent on stone characteristics (diameter greater than 10 mm, number over three) and local anatomy (periampullary diverticula, prior Billroth II gastrectomy). In a young patient with a difficult cannulation of the bile duct and no risk factors for bleeding, EST should probably be preferred over EPBD. In elderly patients with coagulopathy and no risk factors for pancreatitis, EPBD may be preferred.
Keywords: Endoscopic sphincterotomy (EST), Bile duct stone, Endoscopic papillary balloon dilatation (EPBD)
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