Abstract
An 82-year-old man with severe renal dysfunction was admitted because of epigastric pain. Hematological examination revealed elevated levels of hepatic and biliary tract enzymes, and computed tomography showed a hyper-dense lesion with an area of 18×13 mm in the common bile duct. The lesion was diagnosed as a common bile duct stone, and endoscopic retrograde cholangiopancreatography was performed to remove the stone. Following endoscopic sphincterotomy, papillary large balloon dilation was performed using a 10-12 mm balloon catheter. We expanded the balloon to 10 mm, at a pressure of 3 atmospheres, until the notch disappeared. However, bleeding occurred in spurts from the papilla and we were unable to determine the primary bleeding point. We immediately tried to obtain endoscopic hemostasis using a large balloon catheter to provide compression at the bleeding point. Despite maintaining pressure for >30 min with the catheter, we could not control the bleeding. Because our patient was of advanced age with severe complications, we had to adopt a minimally invasive treatment. Therefore, we decided to attempt endoscopic hemostasis by placing a partially-covered self-expandable metallic stent in the distal bile duct [10mm diameter and 4cm length (Boston Scientific WallflexTM)]. The bleeding ceased, and we were able to avoid unnecessary surgery and interventional radiology. The stent was withdrawn 21 days later without complications.
