Endoscopic sphincterotomy vs. endoscopic papillary balloon dilation for choledocholithiasis in patients with liver cirrhosis and coagulopathy.
BACKGROUND
To determine whether endoscopic papillary balloon dilation decreases the risk of hemorrhage without increasing the risk of acute pancreatitis, the results of endoscopic papillary balloon dilation were compared with those of endoscopic biliary sphincterotomy in patients with cirrhosis and coagulopathy.


METHODS
Twenty-one patients with liver cirrhosis with coagulopathy had endoscopic papillary balloon dilation for choledocholithiasis from January 2001 to September 2003. Twenty patients with cirrhosis and coagulopathy who underwent endoscopic biliary sphincterotomy from January 1998 to December 2000, served as a historical control group.


RESULTS
The rate of endoscopic biliary sphincterotomy related hemorrhage was 30% (6/20), whereas the rate for endoscopic papillary balloon dilation related hemorrhage was 0% (p=0.009). With regard to rates of hemorrhage in relation to Child-Pugh class, most (n=5) of the bleeding complications occurred in patients with Child-Pugh class C cirrhosis; bleeding occurred in only one patient with Child-Pugh B cirrhosis. There was no significant difference between the endoscopic biliary sphincterotomy and the endoscopic papillary balloon dilation groups for procedure-related pancreatitis (10% vs. 4.7%, respectively; p>0.05).


CONCLUSIONS
Endoscopic papillary balloon dilation may significantly reduce the risk of bleeding compared with endoscopic biliary sphincterotomy in patients with advanced cirrhosis and coagulopathy. In these patients, the substitution of endoscopic papillary balloon dilation for endoscopic biliary sphincterotomy is recommended for treatment of choledocholithiasis.
Park
Do Hyun
DH
Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, 388-1 Pungnap-dong, Songpa-gu, Seoul 138-736, Seoul, Korea.
Kim
Myung-Hwan
MH
Lee
Sung Koo
SK
Lee
Sang Soo
SS
Choi
Jung Sik
JS
Song
Moon Hee
MH
Seo
Dong Wan
DW
Min
Young Il
YI
D000328:Adult; D000368:Aged; D001778:Blood Coagulation Disorders / Q000453:epidemiology; D002404:Catheterization; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects; D042883:Choledocholithiasis / Q000453:epidemiology / Q000628:therapy*; D015897:Comorbidity; D004384:Duodenoscopy; D005260:Female; D006470:Hemorrhage / Q000517:prevention & control; D006801:Humans; D008103:Liver Cirrhosis / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D010195:Pancreatitis / Q000209:etiology; D011446:Prospective Studies; D016717:Sphincterotomy, Endoscopic / Q000009:adverse effects