Refining papillary balloon dilation: less is better!

摘要

Endoscopic sphincterotomy conquered the biliary system for the endoscopist in the year 1974. This meta-morphed the humble gastrointestinal (GI) endoscopist into a minimally invasive therapist, who could now challenge surgeons to emulate their feats in other areas.The object of war is victory; that of victory is conquest; and that of conquest preservation. (Charles de Secondat).Although sphincterotomy is a prerequisite to most therapeutic endoscopic retrograde cholangiopancreatographies (ERCP), preservation of the anatomical and functional integrity of the sphincter choledochus (Sphincter of Oddi) remains a major concern. Ablation of the sphincter leads not only to duodeno-biliary reflux, a well-known consequence, but also biliary incontinence (i.e. continuous flow as opposed to the rhythmic, well-timed release of bile).