Factors Predictive of Adverse Events Following Endoscopic Papillary Large Balloon Dilation: Results from a Multicenter Series
Soo Jung Park ; Jin Hong Kim ; Dong Ki Lee ; Todd H. Baron ; Hye Sun Lee ; Kyo Tae Jung ; Se Joon Lee ; Hirofumi Kogure ; Hiroyuki Isayama ; Takao Itoi ; Sang-Heum Park ; Jong Ho Moon ; Jong Hyeok Kim ; Hong Ja Kim ; Young Deok Cho ; Sang-Woo Cha ; Seok Jeong ; Don Haeng Lee ; Ho Gak Kim ; Jae Chul Hwang
Digestive Diseases and Sciences, Vol.58(4) : 1100~1109, 2013
Digestive Diseases and Sciences
Lack of established guidelines for endoscopic papillary large balloon dilation (EPLBD) may be a reason for aversion of its use in removal of large common bile duct (CBD) stones.
We sought to identify factors predictive of adverse events (AEs) following EPLBD.
This multicenter retrospective study investigated 946 consecutive patients who underwent attempted removal of CBD stones ≥10 mm in size using EPLBD (balloon size 12-20 mm) with or without endoscopic sphincterotomy (EST) at 12 academic medical centers in Korea and Japan.
Ninety-five (10.0 %) patients exhibited AEs including bleeding in 56, pancreatitis in 24, perforation in nine, and cholangitis in six; 90 (94.7 %) of these were classified as mild or moderate in severity. There were four deaths, three as a result of perforation and one due to delayed massive bleeding. Causative factors identified in fatal cases were full-EST and continued balloon inflation despite a persistent waist seen fluoroscopically. Multivariate analyses showed that cirrhosis (OR 8.03, p = 0.003), length of EST (full-EST: OR 6.22, p < 0.001) and stone size (≥16 mm: OR 4.00, p < 0.001) were associated with increased bleeding, and distal CBD stricture (OR 17.08, p < 0.001) was an independent predictor for perforation. On the other hand, balloon size was associated with deceased pancreatitis (≥14 mm: OR 0.27, p = 0.015).
EPLBD appears to be a safe and effective therapeutic approach for retrieval of large stones in patients without distal CBD strictures and when performed without full-EST.