Introduction : An alternative technique in endoscopic sphincteroplasty is using a large CRE wireguided balloon dilatation as an adjunct to endoscopic sphincterotomy in removing common bile duct (CBD) stone. However, there are few evidence demonstrating the outcomes and complication using CRE balloon dilatation sphincteroplasty during acute phase of cholangitis. This study aims to reveal the outcome of the technique from a single hospital experience.

Methods : A retrospective descriptive study was conducted at the Endoscopy Center of Yan Chai Hospital over a period of 2 years from January 2018 to December 2019. A total of 45 cases was identified where patients, presented with acute cholangitis, had endoscopic papillary balloon dilatation with CRE wireguided balloon during the index admission. Acute cholangitis was defined according to "Tokyo Classication - Cholangitis" (guidelines). Cases with concomitant malignancy and obstruction causes other than common bile duct stones were excluded. The stone clearance rates as defined with occlusive cholangiogram and post ERCP complications were analyzed.

Results : There were 14 (31%) male and 31 (69%) females. Age of the study population ranged from 36-95 years. Stone clearance proven by occlusive cholangiogram in first session was achieved 29/45 (64%) cases. For complication, 6 (13%) cases developed mild papillary bleeding and 3/42 (7%) cases mild pancreatitis. No septic shock was documented.

Conclusions : Endoscopic sphincteroplasty using CRE Wireguided balloon dilatation as an adjunct to endoscopic sphincterotomy is a safe and effective technique for CBD stone removal during acute cholangitis. This procedure can potentially avoid further attempt of ERCP for residual CBD stones.