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Factors predictive of adverse events following endoscopic papillary large balloon dilation: results from a multicenter series.

Authors
Park, SJ; Kim, JH; Hwang, JC; Kim, HG; Lee, DH; Jeong, S; Cha, SW; Cho, YD; Kim, HJ; Moon, JH; Park, SH; Itoi, T; Isayama, H; Kogure, H; Lee, SJ; Jung, KT; Lee, HS; Baron, TH; Lee, DK
Citation
Digestive diseases and sciences, 58(4):1100-1109, 2013
Journal Title
Digestive diseases and sciences
ISSN
0163-21161573-2568
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.
MeSH terms
AdultAgedAged, 80 and overCholangiopancreatography, Endoscopic Retrograde/*adverse effects/mortalityFatal OutcomeFemaleGallstones/*surgeryHumansMaleMiddle AgedRepublic of Korea/epidemiologyRetrospective StudiesTreatment OutcomeYoung Adult
DOI
10.1007/s10620-012-2494-8
PMID
23225136
Appears in Collections:
Journal Papers > School of Medicine / Graduate School of Medicine > Gastroenterology
AJOU Authors
김, 진홍황, 재철
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