EST, EPBD, and EPLBD (cut, stretch, or both?)

Endoscopic treatment of extrahepatic bile duct stones is accepted as a treatment modality that can replace surgery and that is performed globally. The application of endoscopic treatment became possible only after the introduction of endoscopic sphincterotomy (EST), which allowed the removal of a stone from the common bile duct (CBD) that was larger than the papillary orifice. Although the function of an endoscope and its accessories has greatly improved during the past three decades, EST-related complications still remain because the basic concept of EST, which is blind cutting of the tissue with an electric current, has not changed since its introduction.