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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 
Journal Title
 Digestive Diseases and Sciences 
Issue Date
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.
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