Endoscopic papillary balloon dilatation is an alternative to endoscopic sphincterotomy for treating bile duct stones:~easier and as effective. But...~a higher risk of pancreatitis.~Conditions including periampullary diverticulum, prior EST, Billroth-II anastomosis, or distal CBD tapering pose difficulty in EST and lithotripsy with increased risk of complications.~Whether EPBD or EST is superior in efficacy or safety under such circumstances is not clear.
Compare endoscopic papillary balloon dilatation vs. endoscopic sphincterotomy for bile duct stones in:~when sphincterotomy is difficult (periampullary diverticulum, prior sphincterotomy or Billroth II anastomosis)~when there is distal CBD tapering.