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

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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.

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Abbreviations

CBD:

Common bile duct

EPBD:

Endoscopic papillary balloon dilation

EPLBD:

Endoscopic papillary large balloon dilation

EST:

Endoscopic sphincterotomy

MLT:

Mechanical lithotripsy

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Authors and Affiliations

  1. Division of Gastroenterology, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonjuro Gangnam-gu, Seoul, 135-720, Korea

    Soo Jung Park, Se Joon Lee, Kyo Tae Jung & Dong Ki Lee

  2. Department of Gastroenterology, Ajou University Hospital, Ajou University School of Medicine, Suwon, Korea

    Jin Hong Kim & Jae Chul Hwang

  3. Department of Internal Medicine, Daegu Catholic University Medical Center, Catholic University of Daegu School of Medicine, Daegu, Korea

    Ho Gak Kim

  4. Division of Gastroenterology, Department of Internal Medicine, Inha University Hospital, Inha University School of Medicine, Incheon, Korea

    Don Haeng Lee & Seok Jeong

  5. Division of Gastroenterology, Department of Internal Medicine, Eulji University Hospital , Eulji University School of Medicine, Daejeon, Korea

    Sang-Woo Cha

  6. Digestive Disease Center, Department of Internal Medicine, Soon Chun Hyang University Hospital, Soon Chun Hyang University College of Medicine, Seoul, Korea

    Young Deok Cho

  7. Department of Internal Medicine, Dankook University Hospital, Dankook University College of Medicine, Cheonan, Korea

    Hong Ja Kim

  8. Department of Internal Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea

    Jong Hyeok Kim

  9. Digestive Disease Center, Department of Internal Medicine, Soon Chun Hyang University Bucheon Hospital, Soon Chun Hyang University College of Medicine, Bucheon, Korea

    Jong Ho Moon

  10. Digestive Disease Center, Department of Internal Medicine, Soon Chun Hyang University Cheonan Hospital, Soon Chun Hyang University College of Medicine, Cheonan, Korea

    Sang-Heum Park

  11. Department of Gastroenterology and Hepatology, Tokyo Medical University Hospital, Tokyo, Japan

    Takao Itoi

  12. Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan

    Hiroyuki Isayama & Hirofumi Kogure

  13. Department of Biostatistics, Yonsei University College of Medicine, Seoul, Korea

    Hye Sun Lee

  14. Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA

    Todd H. Baron

Authors
  1. Soo Jung Park
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  2. Jin Hong Kim
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  3. Jae Chul Hwang
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  4. Ho Gak Kim
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  5. Don Haeng Lee
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  6. Seok Jeong
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  7. Sang-Woo Cha
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  8. Young Deok Cho
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  9. Hong Ja Kim
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  10. Jong Hyeok Kim
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  11. Jong Ho Moon
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  12. Sang-Heum Park
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  13. Takao Itoi
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  14. Hiroyuki Isayama
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  15. Hirofumi Kogure
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  16. Se Joon Lee
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  17. Kyo Tae Jung
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  18. Hye Sun Lee
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  19. Todd H. Baron
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  20. Dong Ki Lee
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Corresponding author

Correspondence to Dong Ki Lee.

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Park, S.J., Kim, J.H., Hwang, J.C. et al. Factors Predictive of Adverse Events Following Endoscopic Papillary Large Balloon Dilation: Results from a Multicenter Series. Dig Dis Sci 58, 1100–1109 (2013). https://doi.org/10.1007/s10620-012-2494-8

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  • DOI: https://doi.org/10.1007/s10620-012-2494-8

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