Repeated balloon inflation under low pressure may reduce serious adverse events during endoscopic papillary large balloon dilation.

A 93-year-old man was admitted to our hospital for cholangitis caused by multiple CBDSs. After sphincterotomy a 15-18-mm balloon catheter was inserted into the bile duct and positioned across the papilla. The balloon was inflated up to 2 atm and then deflated immediately. At the first inflation, the waist of the balloon remained, so inflation was repeated. At the eighth inflation, the balloon waist disappeared. The CBDSs were completely removed using mechanical lithotripsy (Stone Smash; Boston Scientific Japan, Tokyo, Japan) without crushing the stones (Video S1).