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

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...

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Published in:Digestive diseases and sciences 2013-04, Vol.58 (4), p.1100-1109
Main Authors: Park, Soo Jung, Kim, Jin Hong, Hwang, Jae Chul, Kim, Ho Gak, Lee, Don Haeng, Jeong, Seok, Cha, Sang-Woo, Cho, Young Deok, Kim, Hong Ja, Kim, Jong Hyeok, Moon, Jong Ho, Park, Sang-Heum, Itoi, Takao, Isayama, Hiroyuki, Kogure, Hirofumi, Lee, Se Joon, Jung, Kyo Tae, Lee, Hye Sun, Baron, Todd H., Lee, Dong Ki
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Language:English
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Summary: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  
ISSN:0163-2116
1573-2568
DOI:10.1007/s10620-012-2494-8