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


Ontology type: schema:ScholarlyArticle     


Article Info

DATE

2013-04

AUTHORS

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 Lee

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. More... »

PAGES

1100-1109

Identifiers

URI

http://scigraph.springernature.com/pub.10.1007/s10620-012-2494-8

DOI

http://dx.doi.org/10.1007/s10620-012-2494-8

DIMENSIONS

https://app.dimensions.ai/details/publication/pub.1038215718

PUBMED

https://www.ncbi.nlm.nih.gov/pubmed/23225136


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