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Aim To compare the effectiveness and safety of limited endoscopic sphincterotomy (EST) plus endoscopic papillary balloon dilation (EPBD) with those of major EST alone in patients with large bile duct stones and periampullary diverticula,Methods The records of 89 patients with large common bile duct stones (≥8 mm) and periampullary diverticula who underwent Limited EST plus EPBD (ESBD) or major endoscopic sphincterotomy alone (EST) from July 2007 to December 2013 were retrospectively reviewed.