Complications of endoscopic papillary large-balloon dilatation

Abstract

Endoscopic papillary large balloon dilation (EPLBD) is becoming increasingly popular for the removal of large common bile duct stones. There have been only few studies on the early and late complications of this procedure. We retrospectively reviewed the complications in 18 patients with choledocholith treated by EPLBD at our hospital. The indications for EPLBD were patient age 75 years or older and bile duct and stone diameters greater than 11 mm. After small or medium endoscopic sphincterotomy, we dilated the papilla using a balloon catheter appropriate in diameter for the stones and lower bile duct, and removed the stones using a lithotripter, while watching out for their impaction. Complete removal was achieved in 17 of the 18 patients (94.4%) . Lithotripsy was necessary in two patients (11.1%) , but in most patients even large stones were removed intact. Three (16.7%) patients developed asymptomatic hyperamylasemia, there were no severe complications such as bleeding, perforation or acute pancreatitis. During the follow-up period (mean, 11.0 months ; range, 0.5-17 months) , only one patient developed recurrent stones (5.6%) . The results of this study indicate EPLBD as a useful treatment technique, because of the lower frequency of early complications ; the long-term prognosis is still unclear, and the inclusion criteria for the use of this treatment technique are stringent, e.g., with regard to age.