Efficacy of endoscopic large balloon dilation extended for 2 minutes in bile duct stone removal: A multicenter retrospective study

Abstract

Background/Purpose There is no evidence regarding the optimal balloon dilation time during endoscopic papillary large balloon dilation (EPLBD). The study aim was to evaluate the efficacy of 2‐minute extended balloon dilation for EPLBD. Methods Two hundred and five patients who underwent EPLBD during endoscopic retrograde cholangiopancreatography (ERCP) for bile duct stones at three tertiary centers were included in the analysis. Clinical outcomes and the adverse events were compared between the 0‐minute group (n = 94, balloon deflated immediately after waist disappearance) and the 2‐minute group (n = 111, balloon dilation maintained for 2 minutes after waist disappearance). The risk factors of post‐ERCP pancreatitis (PEP) after EPLBD were assessed. Results There were no significant differences in the stone removal rates and hospitalization periods between the two groups. However, the total ERCP procedure time was significantly shorter in the 2‐minute group (40.6 vs 48.9 min, P = .03). The incidence of PEP was 7.4% in the 0‐minute group and significantly lower at 0.9% in the 2‐minute group (P = .04). Multivariate analysis identified without 2‐minute extended EPLBD as a significant risk factor of PEP (OR: 9.9, P = .045). Conclusions Extension of EPLBD for 2 minutes helped prevent PEP and shortened the procedure time.

One‐stage versus two‐stage endoscopic management for acute cholangitis caused by common bile duct stones: A retrospective multicenter cohort study

“…The inclusion criteria were: (1) patients who underwent ERCP for the management of acute cholangitis caused by CBDS with a naïve papilla, and (2) who had at least one follow-up after the endoscopic procedure. The exclusion criteria were: (1) a prior history of endoscopic management of CBDS; (2) unsuccessful ERCP and convert to percutaneous transhepatic biliary drainage (PTBD) or endoscopic ultrasoundrendezvous (EUS-RV); (3) a prior history of upper gastrointestinal or biliary tract surgery, except for gastrectomy with Billroth I reconstruction and cholecystectomy; (4) presence of bile duct stricture, including primary sclerosing cholangitis; and (5) presence of pancreatobiliary malignancies. The patients were divided into two groups based on the management strategy in ERCP for the acute cholangitis caused by CBDS: the one-stage group, who underwent simultaneous papillary procedure (EST or EPBD or EPLBD) and stone removal in the first ERCP session, and the two-stage group, who underwent only biliary drainage with an endoscopic biliary plastic stent (EBS) or endoscopic nasobiliary drainage tube (ENBD) in the first ERCP and later underwent papillary procedure and stone removal after improvement of the cholangitis.…”

“…In the Tokyo Guidelines 2018, endoscopic biliary drainage is considered the first choice for the treatment of acute cholangitis caused by CBDS. [1][2][3] In the endoscopic management of acute cholangitis, the efficacy and safety of one-stage endoscopic management, where papillary interventions are simultaneously performed such as endoscopic sphincterotomy (EST), endoscopic papillary balloon dilation (EPBD), or endoscopic papillary large balloon dilation (EPLBD) following stone removal with or without biliary drainage, has been reported. [4][5][6][7][8] One-stage endoscopic management has several potential advantages which include a reduction in the number of endoscopic procedures, shortened hospital stay, and reduction in medical costs.…”

“…Acute cholangitis caused by common bile duct stones (CBDS) is a common disease frequently encountered in daily clinical practice. In the Tokyo Guidelines 2018, endoscopic biliary drainage is considered the first choice for the treatment of acute cholangitis caused by CBDS 1–3 . In the endoscopic management of acute cholangitis, the efficacy and safety of one‐stage endoscopic management, where papillary interventions are simultaneously performed such as endoscopic sphincterotomy (EST), endoscopic papillary balloon dilation (EPBD), or endoscopic papillary large balloon dilation (EPLBD) following stone removal with or without biliary drainage, has been reported 4–8 .…”