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Digestive Diseases and Sciences

, Volume 58, Issue 4, pp 1100–1109 | Cite as

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

  • Soo Jung Park
  • Jin Hong Kim
  • Jae Chul Hwang
  • Ho Gak Kim
  • Don Haeng Lee
  • Seok Jeong
  • Sang-Woo Cha
  • Young Deok Cho
  • Hong Ja Kim
  • Jong Hyeok Kim
  • Jong Ho Moon
  • Sang-Heum Park
  • Takao Itoi
  • Hiroyuki Isayama
  • Hirofumi Kogure
  • Se Joon Lee
  • Kyo Tae Jung
  • Hye Sun Lee
  • Todd H. Baron
  • Dong Ki LeeEmail author
Original Article

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.

Keywords

Endoscopic papillary large balloon dilation Adverse event Endoscopic sphincterotomy Choledocholithiasis 

Abbreviations

CBD

Common bile duct

EPBD

Endoscopic papillary balloon dilation

EPLBD

Endoscopic papillary large balloon dilation

EST

Endoscopic sphincterotomy

MLT

Mechanical lithotripsy

Notes

Conflict of interest

None.

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Copyright information

© Springer Science+Business Media New York 2012

Authors and Affiliations

  • Soo Jung Park
    • 1
  • Jin Hong Kim
    • 2
  • Jae Chul Hwang
    • 2
  • Ho Gak Kim
    • 3
  • Don Haeng Lee
    • 4
  • Seok Jeong
    • 4
  • Sang-Woo Cha
    • 5
  • Young Deok Cho
    • 6
  • Hong Ja Kim
    • 7
  • Jong Hyeok Kim
    • 8
  • Jong Ho Moon
    • 9
  • Sang-Heum Park
    • 10
  • Takao Itoi
    • 11
  • Hiroyuki Isayama
    • 12
  • Hirofumi Kogure
    • 12
  • Se Joon Lee
    • 1
  • Kyo Tae Jung
    • 1
  • Hye Sun Lee
    • 13
  • Todd H. Baron
    • 14
  • Dong Ki Lee
    • 1
    Email author
  1. 1.Division of Gastroenterology, Department of Internal Medicine, Gangnam Severance HospitalYonsei University College of MedicineSeoulKorea
  2. 2.Department of Gastroenterology, Ajou University Hospital Ajou University School of MedicineSuwonKorea
  3. 3.Department of Internal Medicine, Daegu Catholic University Medical CenterCatholic University of Daegu School of MedicineDaeguKorea
  4. 4.Division of Gastroenterology, Department of Internal Medicine, Inha University HospitalInha University School of MedicineIncheonKorea
  5. 5.Division of Gastroenterology, Department of Internal Medicine, Eulji University Hospital Eulji University School of MedicineDaejeonKorea
  6. 6.Digestive Disease Center, Department of Internal Medicine, Soon Chun Hyang University HospitalSoon Chun Hyang University College of MedicineSeoulKorea
  7. 7.Department of Internal Medicine, Dankook University HospitalDankook University College of MedicineCheonanKorea
  8. 8.Department of Internal Medicine, Hallym University Sacred Heart HospitalHallym University College of MedicineAnyangKorea
  9. 9.Digestive Disease Center, Department of Internal Medicine, Soon Chun Hyang University Bucheon HospitalSoon Chun Hyang University College of MedicineBucheonKorea
  10. 10.Digestive Disease Center, Department of Internal Medicine, Soon Chun Hyang University Cheonan HospitalSoon Chun Hyang University College of MedicineCheonanKorea
  11. 11.Department of Gastroenterology and HepatologyTokyo Medical University HospitalTokyoJapan
  12. 12.Department of GastroenterologyGraduate School of Medicine, The University of TokyoTokyoJapan
  13. 13.Department of BiostatisticsYonsei University College of MedicineSeoulKorea
  14. 14.Division of Gastroenterology and HepatologyMayo ClinicRochesterUSA

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