title: Case of arterial hemorrhage after endoscopic papillary large balloon dilation for choledocholithiases using a covered self-expandable metallic stent.
abstract: A 78-year-old male was admitted to our hospital because of choledocholithiasis. ERC demonstrated choledocholithiases with a maximum diameter of 13 mm, and we performed endoscopic papillary large balloon dilation (EPLBD) with a size of 15 mm. Immediately following the balloon deflation, spurting hemorrhage occurred from the orifice of the duodenal papilla. Although we performed endoscopic hemostasis by compressing the bleeding point with the large balloon catheter, we could not achieve hemostasis. Therefore, we placed a 10 mm fully covered self-expandable metallic stent (SEMS) across the duodenal papilla, and the hemorrhage stopped immediately. After 1 wk of SEMS placement, duodenal endoscopy revealed ulcerative lesions in both the orifice of the duodenal papilla and the lower bile duct. A direct peroral cholangioscopy using an ultra-slim upper endoscope revealed a visible vessel with a longitudinal mucosal tear in the ulceration of the lower bile duct. We believe that the mucosal tear and subsequent ruptured vessel were caused by the EPLBD procedure.
authors.affiliation: Shuya Shimizu, Itaru Naitoh, Takahiro Nakazawa, Kazuki Hayashi, Katsuyuki Miyabe, Hiromu Kondo, Yuji Nishi, Shuichiro Umemura, Yasuki Hori, Akihisa Kato, Takashi Joh, Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya 467-8601, Japan.
authors.forename: Shuya
authors.initials: S
authors.lastname: Shimizu
authors.affiliation: Shuya Shimizu, Itaru Naitoh, Takahiro Nakazawa, Kazuki Hayashi, Katsuyuki Miyabe, Hiromu Kondo, Yuji Nishi, Shuichiro Umemura, Yasuki Hori, Akihisa Kato, Takashi Joh, Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya 467-8601, Japan.
authors.forename: Itaru
authors.initials: I
authors.lastname: Naitoh
authors.affiliation: Shuya Shimizu, Itaru Naitoh, Takahiro Nakazawa, Kazuki Hayashi, Katsuyuki Miyabe, Hiromu Kondo, Yuji Nishi, Shuichiro Umemura, Yasuki Hori, Akihisa Kato, Takashi Joh, Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya 467-8601, Japan.
authors.forename: Takahiro
authors.initials: T
authors.lastname: Nakazawa
authors.affiliation: Shuya Shimizu, Itaru Naitoh, Takahiro Nakazawa, Kazuki Hayashi, Katsuyuki Miyabe, Hiromu Kondo, Yuji Nishi, Shuichiro Umemura, Yasuki Hori, Akihisa Kato, Takashi Joh, Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya 467-8601, Japan.
authors.forename: Kazuki
authors.initials: K
authors.lastname: Hayashi
authors.affiliation: Shuya Shimizu, Itaru Naitoh, Takahiro Nakazawa, Kazuki Hayashi, Katsuyuki Miyabe, Hiromu Kondo, Yuji Nishi, Shuichiro Umemura, Yasuki Hori, Akihisa Kato, Takashi Joh, Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya 467-8601, Japan.
authors.forename: Katsuyuki
authors.initials: K
authors.lastname: Miyabe
authors.affiliation: Shuya Shimizu, Itaru Naitoh, Takahiro Nakazawa, Kazuki Hayashi, Katsuyuki Miyabe, Hiromu Kondo, Yuji Nishi, Shuichiro Umemura, Yasuki Hori, Akihisa Kato, Takashi Joh, Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya 467-8601, Japan.
authors.forename: Hiromu
authors.initials: H
authors.lastname: Kondo
authors.affiliation: Shuya Shimizu, Itaru Naitoh, Takahiro Nakazawa, Kazuki Hayashi, Katsuyuki Miyabe, Hiromu Kondo, Yuji Nishi, Shuichiro Umemura, Yasuki Hori, Akihisa Kato, Takashi Joh, Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya 467-8601, Japan.
authors.forename: Yuji
authors.initials: Y
authors.lastname: Nishi
authors.affiliation: Shuya Shimizu, Itaru Naitoh, Takahiro Nakazawa, Kazuki Hayashi, Katsuyuki Miyabe, Hiromu Kondo, Yuji Nishi, Shuichiro Umemura, Yasuki Hori, Akihisa Kato, Takashi Joh, Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya 467-8601, Japan.
authors.forename: Shuichiro
authors.initials: S
authors.lastname: Umemura
authors.affiliation: Shuya Shimizu, Itaru Naitoh, Takahiro Nakazawa, Kazuki Hayashi, Katsuyuki Miyabe, Hiromu Kondo, Yuji Nishi, Shuichiro Umemura, Yasuki Hori, Akihisa Kato, Takashi Joh, Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya 467-8601, Japan.
authors.forename: Yasuki
authors.initials: Y
authors.lastname: Hori
authors.affiliation: Shuya Shimizu, Itaru Naitoh, Takahiro Nakazawa, Kazuki Hayashi, Katsuyuki Miyabe, Hiromu Kondo, Yuji Nishi, Shuichiro Umemura, Yasuki Hori, Akihisa Kato, Takashi Joh, Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya 467-8601, Japan.
authors.forename: Akihisa
authors.initials: A
authors.lastname: Kato
authors.affiliation: Shuya Shimizu, Itaru Naitoh, Takahiro Nakazawa, Kazuki Hayashi, Katsuyuki Miyabe, Hiromu Kondo, Yuji Nishi, Shuichiro Umemura, Yasuki Hori, Akihisa Kato, Takashi Joh, Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya 467-8601, Japan.
authors.forename: Hirotaka
authors.initials: H
authors.lastname: Ohara
authors.affiliation: Shuya Shimizu, Itaru Naitoh, Takahiro Nakazawa, Kazuki Hayashi, Katsuyuki Miyabe, Hiromu Kondo, Yuji Nishi, Shuichiro Umemura, Yasuki Hori, Akihisa Kato, Takashi Joh, Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya 467-8601, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Joh
mesh_terms: D000368:Aged; D021721:Balloon Occlusion; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects*; D042883:Choledocholithiasis / Q000175:diagnosis / Q000628:therapy*; D004106:Dilatation / Q000009:adverse effects; D006470:Hemorrhage / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D016558:Hemostasis, Endoscopic; D006801:Humans; D008297:Male; D008670:Metals; D011474:Prosthesis Design; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome; D057772:Vascular System Injuries / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*
chemical_list: D008670:Metals
keywords: Covered self-expandable metallic stent; Direct peroral cholangioscopy; Endoscopic hemostasis; Endoscopic papillary large balloon dilation; Hemorrhage