Endoscopic Papillary Large Balloon Dilation: Guidelines for Pursuing Zero Mortality

Lee, Dong Ki; Han, Jung Woo

doi:10.5946/ce.2012.45.3.299

Cited by 28 publications

(16 citation statements)

References 18 publications

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“…17 The balloon should always be inflated slowly and gradually, starting from a smaller diameter than the intended maximal target, to recognize obscure bile duct strictures with attention paid to the balloon shape under fluoroscopy. 44 3.3. The usual duration of balloon dilation is approximately 30 to 60 seconds after disappearance of the waist.…”

Section: The Balloon Should Be Inflated Slowly In Gradual Stepsmentioning

confidence: 99%

“…The speed and degree of balloon inflation should be carefully controlled to avoid adverse events in view of such obscure strictures of the distal bile duct. 44 If there is a suspicion of distal bile duct strictures during ERCP, especially in patients with a tapered distal bile duct, use of the pulling method of a large inflated retrieval balloon through the suspected site is recommended to confirm a suspected existence. 18 The risk of bleeding with EST depends on the extent of the ampullary incision and underlying conditions such as coagulopathy, use of antithrombotic and antiplatelet medications, cirrhosis, thrombocytopenia, and chronic renal failure.…”

Section: 4mentioning

confidence: 99%

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International consensus guidelines for endoscopic papillary large-balloon dilation

Kim

Seo

et al. 2016

Gastrointestinal Endoscopy

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Section: The Balloon Should Be Inflated Slowly In Gradual Stepsmentioning

confidence: 99%

Section: 4mentioning

confidence: 99%

International consensus guidelines for endoscopic papillary large-balloon dilation

Kim

Seo

et al. 2016

Gastrointestinal Endoscopy

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“…Theoretically, radial force exerted around the surface of the balloon can cause the weakest region of the ampullary mucosa to rupture during the balloon manipulation. For successful EPLBD, proper ballooning size and gradual, cautious dilation are of the utmost importance [32]. …”

Section: Discussionmentioning

confidence: 99%

Efficacy and Safety of Endoscopic Papillary Large Balloon Dilation for Removal of Large Bile Duct Stones in Advanced Age

Kim

2016

Canadian Journal of Gastroenterology and Hepatology

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Objective. Bile duct stone-related adverse events can be detrimental in the elderly. However, little is known about clinical outcomes and adverse events following endoscopic papillary large balloon dilation (EPLBD) in the elderly. The aim of this study was to evaluate the safety and feasibility of EPLBD for the removal of CBD stones in patients aged ≥ 80 years. Methods. A total of 204 patients who underwent EPLBD from 2006 to 2012 were retrospectively reviewed. Patients were classified into two groups (148 patients < 80 years old, Group A; 56 patients ≥ 80 years old, Group B). Endoscopic findings, clinical outcomes, and adverse events in two groups were compared. Results. The number of underlying chronic diseases in Group B was significantly higher than in Group A (P = 0.032). The rates of overall stone clearance were similar between two groups (P = 0.145). No significant difference with regard to post-ERCP pancreatitis between two groups was observed (P = 0.687). All episodes of pancreatitis had full recovery with conservative treatment. One major hemorrhage in Group A was successfully controlled endoscopically and one death caused by retroperitoneal perforation occurred in Group A. Conclusions. EPLBD appear to be safe and effective for CBD stone removal in patients aged ≥ 80 years.

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“…According to the reports [1][2][3][4][5][6][7][8][9], the success rate of CBD stone clearance was similar in EPLBD compared to EST alone. Mechanical use was less frequent in EPLBD, although mechanical usage in large stones was similar.…”

Section: Open Accessmentioning

confidence: 99%

“…Since then, several studies of EPLBD [2][3][4][5][6][7][8][9] for treatment of difficult bile duct stones have reported favorable outcomes and acceptable complication rates. In addition, a recent meta-analysis [10] reported that EPLBD should be considered as an alternative for patients in whom EST could not be routinely performed; it was also recommended for removal of large or difficult common bile duct stones in patients with an underlying coagulopathy or need for anticoagulation following endoscopic retrograde cholangiopancreatography (ERCP) because cases of hemorrhage in EPLBD are fewer than in EST.…”

Section: Introductionmentioning

confidence: 99%

Immediate balloon deflation method in endoscopic papillary large balloon dilation for extraction of difficult bile duct stones

Choi¹,

Kim²,

Kim³

et al. 2013

OJGas

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Background/Aims: Recently, endoscopic papillary large balloon dilation (EPLBD) using a large balloon (12 -20 mm) for extraction of difficult common bile duct (CBD) stones has been widely accepted with favorable outcomes. However, there is no consensus with regard to the ballooning time. The aim of our study was to evaluate the efficacy and safety of immediate balloon deflation in EPLBD for the treatment of difficult bile duct stone. Methods: This was a retrospective study of 80 consecutive patients with bile duct stones who were treated with an immediate balloon deflation method in EPLBD combined with endoscopic sphincterotomy (EST) between January 2010 and December 2012. Overall success rate, success rate at first ERCP, and the frequency of mechanical lithotripsy for complete stone removal were assessed for efficacy and safety was evaluated by assessing major complications. Results: Overall success rate for complete stone removal was high (78/80, 97.5%) and success rate for complete stone removal at first ERCP was 86.3% (69/80). The use of mechanical lithotripsy was 0% (0/80). The overall complication rate was favorable (5/80, 6.3%). PostERCP pancreatitis was observed in 3 patients (two: mild, one: moderate). In subgroup analysis, the presence of periampullary diverticulum was the only factor affecting the success rate at first ERCP. Conclusion: This study demonstrated the favorable outcome of immediate balloon deflation for treatment of difficult CBD stones and can be considered for clinical application.

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Endoscopic Papillary Large Balloon Dilation: Guidelines for Pursuing Zero Mortality

Cited by 28 publications

References 18 publications

International consensus guidelines for endoscopic papillary large-balloon dilation

International consensus guidelines for endoscopic papillary large-balloon dilation

Efficacy and Safety of Endoscopic Papillary Large Balloon Dilation for Removal of Large Bile Duct Stones in Advanced Age

Immediate balloon deflation method in endoscopic papillary large balloon dilation for extraction of difficult bile duct stones

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