Large-balloon technique for one-step endoscopic biliary stenting in patients with an inaccessible major papilla owing to difficult duodenal stricture (with video).
BACKGROUND
Marked duodenal stenosis makes endoscopic biliary stenting (EBS) impossible, although it is the most common method for treating obstructive jaundice in patients with benign or malignant biliary strictures. Large-balloon dilation can be used to enable endoscope passage in the GI tract.


OBJECTIVE
We describe 4 cases of successful EBS combined with the use of a large balloon for the treatment of difficult duodenal strictures in patients with benign and malignant biliary strictures.


METHODS
A retrospective case series.


METHODS
Two tertiary referral centers.


METHODS
Four patients: 1 with hilar carcinoma, 1 with gallbladder carcinoma, and 2 with chronic pancreatitis.


METHODS
After duodenal dilation, the slightly deflated balloon was pushed with the endoscope into the major papilla through the duodenal stricture (pushing method used in 2 patients). In the cases in which the major papilla was not accessible with the pushing method, a large dilation balloon was deflated completely after dilation, advanced beyond the stricture into the third portion of the duodenum, and reinflated to the maximum size. Pulling the dilation balloon catheter into the working channel while hooking the inflated balloon as the anchor at the anal side of the duodenal stricture, the endoscope was straightened to advance to the major papilla (hooking method used in 2 patients).


METHODS
Successful EBS.


RESULTS
Reaching the major papilla and EBS was accomplished in all 4 patients.


CONCLUSIONS
Small number of cases.


CONCLUSIONS
Use of large-balloon dilation can contribute to successful ERCP in patients with difficult duodenal strictures.
Kikuyama
Masataka
M
Department of Gastroenterology, Hamamatsu Rosai Hospital, Shizuoka, Japan.
Itoi
Takao
T
Sasada
Yuzo
Y
Sofuni
Atsushi
A
Ota
Yuji
Y
Itokawa
Fumihide
F
D000328:Adult; D000368:Aged; D014670:Ampulla of Vater; D002404:Catheterization / Q000379:methods*; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000379:methods*; D002761:Cholangitis / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D002779:Cholestasis / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D004380:Duodenal Obstruction / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D018570:Risk Assessment; D012720:Severity of Illness Index; D015607:Stents; D015996:Survival Rate; D016896:Treatment Outcome