title: Large-diameter biliary orifice balloon dilation to aid in endoscopic bile duct stone removal: a multicenter series.
abstract: BACKGROUND
  The utility and safety of endoscopic biliary orifice balloon dilation (EBD) for bile duct stone removal (with use of large-diameter balloons) after biliary endoscopic sphincterotomy (BES) is currently not well established.
  
  
  OBJECTIVE
  Our purpose was to evaluate the efficacy and complications of BES followed by > or = 12 mm diameter EBD for bile duct stone removal.
  
  
  METHODS
  Retrospective, multicenter series.
  
  
  METHODS
  Five ERCP referral centers in the United States.
  
  
  METHODS
  Patients who underwent attempted removal of bile duct stones by BES followed by EBD with > or = 12 mm diameter dilating balloons were identified by searching the prospectively recorded endoscopic databases from 1999 to 2007. Clinical parameters, endoscopic data, and outcomes were collected and analyzed.
  
  
  RESULTS
  One hundred three patients, mean age 70 +/- 17 years (range 23-98 years), with 56 (54%) women, underwent 107 procedures. Eleven patients (11%) had a prior history of acute pancreatitis. Pancreatogram was performed in 15 (14%) patients. Median stone size and median balloon diameter used was 13 mm. Complete stone removal in the first session of EBD was accomplished in 102 (95%) procedures, and mechanical lithotripsy was required in 29 (27%). Six patients (5.4%) had documented procedure-related complications including one patient with severe bleeding and one with severe cystic duct perforation. No acute pancreatitis occurred.
  
  
  CONCLUSIONS
  EBD with a large-diameter balloon in conjunction with BES for bile duct stone removal is effective and relatively safe. This technique appears to be a reasonable alternative option when standard BES and basket or balloon sweep are inadequate to remove bile duct stones.
authors.affiliation: Division of Gastroenterology/Hepatology, Indiana University School of Medicine, Indianapolis, Indiana, USA.
authors.forename: Siriboon
authors.initials: S
authors.lastname: Attasaranya
authors.forename: Young Koog
authors.initials: YK
authors.lastname: Cheon
authors.forename: Harsha
authors.initials: H
authors.lastname: Vittal
authors.forename: Douglas A
authors.initials: DA
authors.lastname: Howell
authors.forename: Donald E
authors.initials: DE
authors.lastname: Wakelin
authors.forename: John T
authors.initials: JT
authors.lastname: Cunningham
authors.forename: Niraj
authors.initials: N
authors.lastname: Ajmere
authors.forename: Ronald W
authors.initials: RW
authors.lastname: Ste Marie
authors.forename: Kanishka
authors.initials: K
authors.lastname: Bhattacharya
authors.forename: Kapil
authors.initials: K
authors.lastname: Gupta
authors.forename: Martin L
authors.initials: ML
authors.lastname: Freeman
authors.forename: Stuart
authors.initials: S
authors.lastname: Sherman
authors.forename: Lee
authors.initials: L
authors.lastname: McHenry
authors.forename: James L
authors.initials: JL
authors.lastname: Watkins
authors.forename: Evan L
authors.initials: EL
authors.lastname: Fogel
authors.forename: Suzette
authors.initials: S
authors.lastname: Schmidt
authors.forename: Glen A
authors.initials: GA
authors.lastname: Lehman
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002404:Catheterization / Q000379:methods*; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000379:methods*; D042883:Choledocholithiasis / Q000175:diagnosis* / Q000628:therapy*; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008096:Lithotripsy / Q000379:methods; D008297:Male; D008875:Middle Aged; D015337:Multicenter Studies as Topic; D011336:Probability; D012189:Retrospective Studies; D018570:Risk Assessment; D016896:Treatment Outcome