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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

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, 진홍  |  황, 재철
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