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Factors Predictive of Adverse Events Following Endoscopic Papillary Large Balloon Dilation: Results from a Multicenter Series

Authors
 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 
Citation
 Digestive Diseases and Sciences, Vol.58(4) : 1100-1109, 2013 
Journal Title
 Digestive Diseases and Sciences 
ISSN
 0163-2116 
Issue Date
2013
Abstract
BACKGROUND: 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. AIMS: We sought to identify factors predictive of adverse events (AEs) following EPLBD. METHODS: 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. RESULTS: 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). CONCLUSIONS: 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.
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/86676
DOI
10.1007/s10620-012-2494-8
Appears in Collections:
1. Journal Papers (연구논문) > 1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실)
Yonsei Authors
박수정(Park, Soo Jung) ; 이동기(Lee, Dong Ki) ; 이세준(Lee, Se Joon) ; 정교태(Jung, Kyo Tae)
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Full Text
http://link.springer.com/article/10.1007%2Fs10620-012-2494-8
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