Effects of large-balloon dilation on the major duodenal papilla and the lower bile duct: histological evaluation by using an ex vivo adult porcine model.
BACKGROUND
Several articles have reported the usefulness of large-balloon dilation after endoscopic sphincterotomy in removing bile duct stones. Its histological effect on the duodenal papilla and the lower bile duct, however, is not well established.


OBJECTIVE
To elucidate the histological consequence of large-balloon dilation.


METHODS
Animal experiment.


METHODS
A referral center.


METHODS
After the evaluation of normal anatomy of the major duodenal papilla and the lower bile duct in resected specimens from pigs, large-balloon dilation (12-20 mm) after small sphincterotomy was performed, and serial tissue sections were assessed for morphological changes.


METHODS
Macroscopic and microscopic findings of the duodenal papilla and the lower bile duct after large balloon dilation, with special interest in ductal wall disruption and perforation.


RESULTS
The porcine specimens were comparable in size to humans. Balloons with diameters 12 mm or larger caused disruption of the ductal walls, and those 15 mm or larger resulted in perforation of the surrounding adipose tissue. The frequency of disruption and perforation increased in proportion to the balloon diameters.


CONCLUSIONS
Other sequelae including hemorrhage, pancreatitis, acute inflammatory changes, and late fibrosis could not be investigated in our ex vivo porcine model.


CONCLUSIONS
Dilation with large balloons can tear the bile duct wall and cause potential impairment of sphincter function and overdilation of small extrahepatic bile ducts.
Hisatomi
Kantaro
K
Department of Gastroenterology, Kanto Medical Center Nippon Telegraph and Telephone East Corporation, Tokyo, Japan.
Ohno
Akiko
A
Tabei
Kouichi
K
Kubota
Kensuke
K
Matsuhashi
Nobuyuki
N
D014670:Ampulla of Vater / Q000473:pathology*; D000818:Animals; D017734:Bile Ducts, Extrahepatic / Q000473:pathology*; D002404:Catheterization / Q000295:instrumentation*; D004195:Disease Models, Animal; D004867:Equipment Design; D042882:Gallstones / Q000473:pathology / Q000628:therapy*; D016717:Sphincterotomy, Endoscopic / Q000295:instrumentation*; D013552:Swine