title: Endoscopic papillary balloon dilation for bile duct stones in patients on hemodialysis.
abstract: BACKGROUND
  Endoscopic papillary balloon dilation (EPBD) is a less hazardous alternative to endoscopic sphincterotomy for managing bile duct stones in patients with a coagulopathy. However, little information on EPBD is available for patients with bile duct stones who are undergoing hemodialysis (HD). We aimed to evaluate the safety and efficacy of EPBD for such patients.
  
  
  METHODS
  This was a retrospective cohort study with prospectively collected data for 37consecutive patients with bile duct stones who were undergoing HD and who also underwent EPBD between December 1995 and April 2010 at four institutions in Tokyo, Japan. The main outcome was the safety and efficacy of EPBD for managing bile duct stones in patients undergoing HD.
  
  
  RESULTS
  The bile duct stones were completely removed in one session in 24 patients (64.8%). Overall success was achieved using EPBD alone in all patients. Complications occurred in five patients (13.5%), including two with hemorrhage (5.4%). No hemorrhage developed in any of the 33 patients who had no additional bleeding risk except for HD. Pancreatitis and perforation developed in two (5.4%) and one (2.7%) patient, respectively.
  
  
  CONCLUSIONS
  EPBD seems to be a safe and effective treatment to extract bile duct stones in patients undergoing HD. However, EPBD should be performed carefully in patients with additional bleeding risk factors, such as Child-Pugh class C liver cirrhosis and those taking anti-platelet agents at the time of EPBD.
authors.affiliation: Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
authors.forename: Naminatsu
authors.initials: N
authors.lastname: Takahara
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Isayama
authors.forename: Takashi
authors.initials: T
authors.lastname: Sasaki
authors.forename: Takeshi
authors.initials: T
authors.lastname: Tsujino
authors.forename: Nobuo
authors.initials: N
authors.lastname: Toda
authors.forename: Naoki
authors.initials: N
authors.lastname: Sasahira
authors.forename: Suguru
authors.initials: S
authors.lastname: Mizuno
authors.forename: Kazumichi
authors.initials: K
authors.lastname: Kawakubo
authors.forename: Hirofumi
authors.initials: H
authors.lastname: Kogure
authors.forename: Natsuyo
authors.initials: N
authors.lastname: Yamamoto
authors.forename: Yousuke
authors.initials: Y
authors.lastname: Nakai
authors.forename: Kenji
authors.initials: K
authors.lastname: Hirano
authors.forename: Minoru
authors.initials: M
authors.lastname: Tada
authors.forename: Masao
authors.initials: M
authors.lastname: Omata
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Koike
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D042882:Gallstones / Q000601:surgery*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011446:Prospective Studies; D006435:Renal Dialysis; D012189:Retrospective Studies; D016717:Sphincterotomy, Endoscopic / Q000379:methods*; D016896:Treatment Outcome