Year 2012 / Volume 104 / Number 7
Editorial
Endoscopic biliary sphincterotomy dilation

pp. 339-342

Jesús García-Cano

Abstract
The year 2013 will mark the 40th anniversary of the introduction of endoscopic biliary sphincteroromy (EBS) in the therapeutic armamentarium for the treatment of common bile duct obstruction. Early EBS procedures were performed for the removal of common bile duct stones, which still is a primary indication. EBS was the first ther- apeutic step for endoscopic retrograde cholangiopancreatography (ERCP), which was first carried out for diagnostic purposes 1968.
On August 19, 1974 Professor Kawai, one of the pioneers of EBS, reported his initial experience at Centro Médico Nacional de México during the 3rd International Congress of Gastrointestinal Endoscopy.

The innovation was welcomed as an extraordinary achievement and all attendants applauded what was deemed to become a major milestone for therapeutic digestive endoscopy (1). The sphincterotome likely represents the device with the best cost-benefit ratio for the endoscopic treatment of digestive diseases.
Intially, following EBS, stones were usually left within the common bile duct to allow for their spontaneous expulsion. Complications such as cholangitis led to the use of Fogarty-type balloon catheters and Dormia baskets for their extraction during ERCP.

It was soon observed that 100% of common bile duct stones could not be removed with a single ERCP-EBS procedure using only these balloons and baskets (Table I). Failure was usually associated with disparity between stone size and sphincterotomy size, which commonly cannot exceed 15 mm. Various factors may influence a sphinc- terotomy’s smaller size, including a juxtadiverticular papilla of Vater and coagulation disorders.
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