Large-diameter biliary orifice balloon dilation to aid in endoscopic bile duct stone removal: a multicenter series.
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.
Attasaranya
Siriboon
S
Division of Gastroenterology/Hepatology, Indiana University School of Medicine, Indianapolis, Indiana, USA.
Cheon
Young Koog
YK
Vittal
Harsha
H
Howell
Douglas A
DA
Wakelin
Donald E
DE
Cunningham
John T
JT
Ajmere
Niraj
N
Ste Marie
Ronald W
RW
Bhattacharya
Kanishka
K
Gupta
Kapil
K
Freeman
Martin L
ML
Sherman
Stuart
S
McHenry
Lee
L
Watkins
James L
JL
Fogel
Evan L
EL
Schmidt
Suzette
S
Lehman
Glen A
GA
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