Endoscopic papillary large balloon dilation (EPLBD) is an effective technique for
removing large or stacked bile duct stones [1]. However, slippage during dilation is a common challenge, often prolonging procedures,
necessitating multiple attempts, and increasing the risk of adverse events. This issue
is more pronounced with larger EPLBD balloons compared to standard endoscopic papillary
balloon dilation. Although longer balloons may reduce slippage, they can cause unnecessary
dilation beyond the papilla and are challenging to use in cases where stones are located
near the papilla. Additionally, maintaining an adequate distance between the endoscope
and the papilla can be challenging during the procedure.
To address these limitations, we developed a novel EPLBD balloon catheter (RIGEL;
Japan Lifeline, Tokyo, Japan) ([Fig. 1]), with a length of 25 mm—shorter than conventional EPLBD balloons, which are typically
40–50 mm. This catheter includes an elastic band at its middle, which delays the expansion
of the central segment, effectively preventing slippage [2]. Its tapered ends reduce the risk of stone entrapment between the balloon and the
bile duct wall, particularly in cases involving impacted stones in the distal bile
duct.
Fig. 1 A novel endoscopic papillary large balloon dilation catheter (RIGEL; Japan Lifeline,
Tokyo, Japan) with a length of 25 mm, which is shorter than the conventional balloons
that typically have a length of 40–50 mm. a–b The balloon features an elastic band in the middle (a), causing the central part to expand with a delay to prevent slippage (b). c Its tapered ends (arrow) reduce the risk of stone entrapment between the balloon
and bile duct wall, particularly in cases of impacted stones in the distal bile duct.
A 75-year-old man presented with jaundice and cholangitis caused by common bile duct
stones. After successful bile duct cannulation, cholangiography revealed a large stone
impacted in the distal end of the common bile duct. Following endoscopic sphincterotomy,
a RIGEL balloon (12×25 mm) was inserted, with the band positioned at the papilla.
The balloon was inflated to 6 atm, and its central segment expanded with a delay,
allowing precise papillary dilation on the first attempt without slippage. Although
the stone was located near the papilla, it shifted toward the liver during dilation
without becoming trapped ([Fig. 2], [Video 1]). The stone was subsequently removed using a basket and balloon catheters. The patient’s
symptoms resolved rapidly, and no adverse events were observed.
Fig. 2
a After successful bile duct cannulation, cholangiography revealed a large stone (arrow)
impacted in the distal end of the common bile duct. Following endoscopic sphincterotomy,
the RIGEL balloon (12×25 mm) was inserted, and the band was positioned at the papilla.
The balloon was subsequently inflated to 6 atm. The central part of the balloon expanded
with a delay to ensure appropriate papillary dilation on the first attempt without
slippage. b Although the stone was located near the papilla, it migrated toward the liver (arrow)
during the dilation without becoming trapped.
Endoscopic papillary large balloon dilation using a novel nonslip short-length balloon
in a 75-year-old patient with a large impacted stone in the distal common bile duct.Video
1
Endoscopy_UCTN_Code_TTT_1AR_2AC
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