Balloons larger than 15 mm can increase the risk of adverse events following endoscopic papillary large balloon dilation

Lee, Gil‐Ho; Yang, Min Jae; Kim, Jin Hong; Hwang, Jae Chul; Yoo, Byung Moo; Lee, Dong Ki; Jang, Sung Ill; Lee, Tae Hoon; Park, Sang Heum; Park, Jin Seok; Jeong, Seok; Lee, Don Haeng

doi:10.1111/jgh.14749

Cited by 8 publications

(4 citation statements)

References 13 publications

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“…In a Korean study analyzing 672 papillary/biliary large balloon dilation for difficult stones, perforations and fatal complications occurred only in patients dilated from >15 to 20 mm. No perforation was observed in patients dilated from 12 to 15 mm [16] and in our technique, we never dilate >15 mm. The presence of a stone could increase the risk of perforation, but this was not observed in our study as well as in the one by Park et al [9] and 2 other case reports [7, 8].…”

Section: Discussionmentioning

confidence: 82%

Endoscopic Biliary Large Balloon Dilation Lithotripsy for Giant and Impacted Stones Removal: A Western Series

Lima

Sanmartin

Onófrio

et al. 2020

Dig Dis

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Background: Endoscopic removal of packed, large, or impacted stones, in which a basket cannot be deployed or is unable to grasp the stone(s), is challenging and inevitably leads to repeated procedures such as stent insertion and extra- or intracorporal lithotripsy. In this study, we describe the results of an alternative stone disintegration technique in a considerable series of patients using an esophageal/pyloric balloon for stone fragmentation or making working space in the bile duct to allow the deployment of the basket, a technique we call endoscopic biliary large balloon lithotripsy. Methods: We retrieved data from 1,429 endoscopic retrograde cholangiopancreatographies (ERCPs) from 2 prospective trials performed between 2014 and 2019. Patients with difficult bile duct stones, in which a balloon dilator up to 15 mm was used to crush or increase the working space parallel to the stones in the common or hepatic duct, were included in the study. Results: From the 1,429 ERCPs, 299 had difficult stones (>1 cm, impacted or multiple stones). Large balloon lithotripsy was employed in 46 cases after endoscopic papillotomy and endoscopic biliary large balloon dilation with failed attempted balloon or basket stone(s) extraction. Failure to clear the bile duct at first ERCP occurred in 4 cases (91.3% of success). Complications were observed in 5 patients (10.8%; 1 perforation, 1 pancreatitis, and 3 bleedings), who were treated conservatively. Conclusions: Large balloon lithotripsy, in order to crush the stones or make working room for baskets or balloons in the bile duct, is an effective, safe, and low cost technique for impacted, packed, or giant bile duct stones.

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Section: Discussionmentioning

confidence: 82%

Endoscopic Biliary Large Balloon Dilation Lithotripsy for Giant and Impacted Stones Removal: A Western Series

Lima

Sanmartin

Onófrio

et al. 2020

Dig Dis

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“…In a Korean study analyzing 672 EBLBD for difficult stones, perforations and fatal complications only occurred in patients dilated > 15-20 mm. No perforation was observed in patients dilated 12-15 mm[ 11 ].…”

Section: Discussionmentioning

confidence: 99%

Feasibility of endoscopic papillary large balloon dilation to remove difficult stones in patients with nondilated distal bile ducts

Lima¹,

Moresco²,

Sanmartin³

et al. 2022

WJGE

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BACKGROUND Current guidelines recommend not performing papillary large balloon dilation in patients with nondilated distal bile ducts. AIM To assess the feasibility of balloon dilation to remove difficult stones in patients with nondilated distal bile ducts. METHODS Data from 1289 endoscopic retrograde cholangiopancreatography (ERCP) procedures were obtained from two prospective studies. While 258 cases had difficult stones (> 1 cm, multiple > 8, impacted, or having a thin distal duct), 191 underwent biliary dilation up to 15 mm after endoscopic sphincterotomy. Cholangiographies of these cases were retrospectively reviewed in order to classify the distal bile duct and both the stone size and number. Primary outcomes were clearance rate at first ERCP and complications. RESULTS Of the 191 patients (122 women and 69 men; mean age: 60 years) who underwent biliary dilation for difficult stones, 113 (59%) had a nondilated or tapered distal duct. Patients with a dilated distal duct were older than those with nondilated distal ducts (mean 68 and 52 years of age, respectively; P < 0.05), had more stones (median 4 and 2 stones per patient, respectively; P < 0.05), and had less need for additional mechanical lithotripsy (6.4% vs 25%, respectively; P < 0.05). Clearance rate at first ERCP was comparable between patients with a dilated (73/78; 94%) and nondilated distal ducts (103/113; 91%). Procedures were faster in patients with a dilated distal duct (mean 17 vs 24 min, respectively; P < 0.005). Complications were similar in both groups (6.4% vs 7.1%, respectively). CONCLUSION Large balloon dilation for difficult stones is feasible in patients with a nondilated or even tapered distal duct.

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“…Nevertheless, our findings revealed that overdilation is not a significant factor associated with perforation. Furthermore, several prior studies that performed overdilation revealed that overdilation is not a risk factor for adverse events [7,12,16] and that fatal perforation cases without overdilation have occurred when using a balloon > 15 mm [17]. This may be due to the fact that, unlike pigs, humans have SP.…”

Section: Discussionmentioning

confidence: 99%

Risk Factors for Perforation During Endoscopic Papillary Large Balloon Dilation and Bile Duct Stone Removal

et al. 2021

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Background Stone removal using endoscopic papillary large balloon dilation (EPLBD) is extremely effective. However, limited research exists regarding the risk factors for perforation of the duodenal papilla and bile duct, which may be fatal. Aims We aimed to investigate the risk factors for perforation during EPLBD + stone removal. Methods We included patients who underwent EPLBD + stone removal at four medical facilities between January 2008 and December 2018. We retrospectively analyzed the risk factors for perforation and their relationship between overdilation and adverse events. Overdilation was defined as a ratio of the balloon diameter to the diameter of the bile duct that exceeded 100%. The diameter of the distal bile duct was measured using the diameter of the intrapancreatic bile duct at a point 10 mm toward the liver from the narrow distal segment on a cholangiogram. ResultsWe included 310 patients (177 males; median age: 79 years [range: 46-102 years]). Perforation occurred in five patients (1.6%). Multivariate analysis indicated that no surrounding-pancreas (half or less of the circumference of the intrapancreatic bile duct was surrounded by the pancreatic parenchyma) was a significant risk factor (perforation rate: 8.3%, p = 0.011, odds ratio: 12.7 [95% confidence interval: 1.8-90.5]). No significant difference was found between the overdilation and non-overdilation groups regarding the occurrence of pancreatitis, bleeding, and cholangitis. Perforation rate in patients with no surrounding pancreas + overdilation was 16.7% (2/12). Patients with perforation underwent conservative therapy, which improved their conditions. Conclusions EPLBD + stone removal should be avoided in patients with no surrounding pancreas. Overdilation is not a risk factor for adverse procedural events; however, it should be limited in patients with surrounding pancreas.

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Balloons larger than 15 mm can increase the risk of adverse events following endoscopic papillary large balloon dilation

Cited by 8 publications

References 13 publications

Endoscopic Biliary Large Balloon Dilation Lithotripsy for Giant and Impacted Stones Removal: A Western Series

Endoscopic Biliary Large Balloon Dilation Lithotripsy for Giant and Impacted Stones Removal: A Western Series

Feasibility of endoscopic papillary large balloon dilation to remove difficult stones in patients with nondilated distal bile ducts

Risk Factors for Perforation During Endoscopic Papillary Large Balloon Dilation and Bile Duct Stone Removal

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