Factors predictive of adverse events following endoscopic papillary large balloon dilation: Results from a multicenter series

Soo Jung Park, Jin Hong Kim, Jae Chul Hwang, Ho Gak Kim, Don Haeng Lee, Seok Jeong, Sang Woo Cha, Young Deok Cho, Hong Ja Kim, Jong Hyeok Kim, Jong Ho Moon, Sang Heum Park, Takao Itoi, Hiroyuki Isayama, Hirofumi Kogure, Se Joon Lee, Kyo Tae Jung, Hye Sun Lee, Todd H. Baron, Dong Ki Lee

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Abstract

Background: Lack of established guidelines for endoscopic papillary large balloon dilation (EPLBD) may be a reason for aversion of its use in removal of large common bile duct (CBD) stones. Aims: We sought to identify factors predictive of adverse events (AEs) following EPLBD. Methods: This multicenter retrospective study investigated 946 consecutive patients who underwent attempted removal of CBD stones ≥10 mm in size using EPLBD (balloon size 12-20 mm) with or without endoscopic sphincterotomy (EST) at 12 academic medical centers in Korea and Japan. Results: Ninety-five (10.0 %) patients exhibited AEs including bleeding in 56, pancreatitis in 24, perforation in nine, and cholangitis in six; 90 (94.7 %) of these were classified as mild or moderate in severity. There were four deaths, three as a result of perforation and one due to delayed massive bleeding. Causative factors identified in fatal cases were full-EST and continued balloon inflation despite a persistent waist seen fluoroscopically. Multivariate analyses showed that cirrhosis (OR 8.03, p = 0.003), length of EST (full-EST: OR 6.22, p < 0.001) and stone size (≥16 mm: OR 4.00, p < 0.001) were associated with increased bleeding, and distal CBD stricture (OR 17.08, p < 0.001) was an independent predictor for perforation. On the other hand, balloon size was associated with deceased pancreatitis (≥14 mm: OR 0.27, p = 0.015). Conclusions: EPLBD appears to be a safe and effective therapeutic approach for retrieval of large stones in patients without distal CBD strictures and when performed without full-EST.

Original languageEnglish
Pages (from-to)1100-1109
Number of pages10
JournalDigestive diseases and sciences
Volume58
Issue number4
DOIs
Publication statusPublished - 2013 Apr 1

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Endoscopic Sphincterotomy
Common Bile Duct
Dilatation
Hemorrhage
Pancreatitis
Pathologic Constriction
Cholangitis
Economic Inflation
Korea
Multicenter Studies
Japan
Fibrosis
Multivariate Analysis
Retrospective Studies
Guidelines

All Science Journal Classification (ASJC) codes

  • Physiology
  • Gastroenterology

Cite this

Park, Soo Jung ; Kim, Jin Hong ; Hwang, Jae Chul ; Kim, Ho Gak ; Lee, Don Haeng ; Jeong, Seok ; Cha, Sang Woo ; Cho, Young Deok ; Kim, Hong Ja ; Kim, Jong Hyeok ; Moon, Jong Ho ; Park, Sang Heum ; Itoi, Takao ; Isayama, Hiroyuki ; Kogure, Hirofumi ; Lee, Se Joon ; Jung, Kyo Tae ; Lee, Hye Sun ; Baron, Todd H. ; Lee, Dong Ki. / Factors predictive of adverse events following endoscopic papillary large balloon dilation : Results from a multicenter series. In: Digestive diseases and sciences. 2013 ; Vol. 58, No. 4. pp. 1100-1109.
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title = "Factors predictive of adverse events following endoscopic papillary large balloon dilation: Results from a multicenter series",
abstract = "Background: Lack of established guidelines for endoscopic papillary large balloon dilation (EPLBD) may be a reason for aversion of its use in removal of large common bile duct (CBD) stones. Aims: We sought to identify factors predictive of adverse events (AEs) following EPLBD. Methods: This multicenter retrospective study investigated 946 consecutive patients who underwent attempted removal of CBD stones ≥10 mm in size using EPLBD (balloon size 12-20 mm) with or without endoscopic sphincterotomy (EST) at 12 academic medical centers in Korea and Japan. Results: Ninety-five (10.0 {\%}) patients exhibited AEs including bleeding in 56, pancreatitis in 24, perforation in nine, and cholangitis in six; 90 (94.7 {\%}) of these were classified as mild or moderate in severity. There were four deaths, three as a result of perforation and one due to delayed massive bleeding. Causative factors identified in fatal cases were full-EST and continued balloon inflation despite a persistent waist seen fluoroscopically. Multivariate analyses showed that cirrhosis (OR 8.03, p = 0.003), length of EST (full-EST: OR 6.22, p < 0.001) and stone size (≥16 mm: OR 4.00, p < 0.001) were associated with increased bleeding, and distal CBD stricture (OR 17.08, p < 0.001) was an independent predictor for perforation. On the other hand, balloon size was associated with deceased pancreatitis (≥14 mm: OR 0.27, p = 0.015). Conclusions: EPLBD appears to be a safe and effective therapeutic approach for retrieval of large stones in patients without distal CBD strictures and when performed without full-EST.",
author = "Park, {Soo Jung} and Kim, {Jin Hong} and Hwang, {Jae Chul} and Kim, {Ho Gak} and Lee, {Don Haeng} and Seok Jeong and Cha, {Sang Woo} and Cho, {Young Deok} and Kim, {Hong Ja} and Kim, {Jong Hyeok} and Moon, {Jong Ho} and Park, {Sang Heum} and Takao Itoi and Hiroyuki Isayama and Hirofumi Kogure and Lee, {Se Joon} and Jung, {Kyo Tae} and Lee, {Hye Sun} and Baron, {Todd H.} and Lee, {Dong Ki}",
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Park, SJ, Kim, JH, Hwang, JC, Kim, HG, Lee, DH, Jeong, S, Cha, SW, Cho, YD, Kim, HJ, Kim, JH, Moon, JH, Park, SH, Itoi, T, Isayama, H, Kogure, H, Lee, SJ, Jung, KT, Lee, HS, Baron, TH & Lee, DK 2013, 'Factors predictive of adverse events following endoscopic papillary large balloon dilation: Results from a multicenter series', Digestive diseases and sciences, vol. 58, no. 4, pp. 1100-1109. https://doi.org/10.1007/s10620-012-2494-8

Factors predictive of adverse events following endoscopic papillary large balloon dilation : Results from a multicenter series. / Park, Soo Jung; Kim, Jin Hong; Hwang, Jae Chul; Kim, Ho Gak; Lee, Don Haeng; Jeong, Seok; Cha, Sang Woo; Cho, Young Deok; Kim, Hong Ja; Kim, Jong Hyeok; Moon, Jong Ho; Park, Sang Heum; Itoi, Takao; Isayama, Hiroyuki; Kogure, Hirofumi; Lee, Se Joon; Jung, Kyo Tae; Lee, Hye Sun; Baron, Todd H.; Lee, Dong Ki.

In: Digestive diseases and sciences, Vol. 58, No. 4, 01.04.2013, p. 1100-1109.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Factors predictive of adverse events following endoscopic papillary large balloon dilation

T2 - Results from a multicenter series

AU - Park, Soo Jung

AU - Kim, Jin Hong

AU - Hwang, Jae Chul

AU - Kim, Ho Gak

AU - Lee, Don Haeng

AU - Jeong, Seok

AU - Cha, Sang Woo

AU - Cho, Young Deok

AU - Kim, Hong Ja

AU - Kim, Jong Hyeok

AU - Moon, Jong Ho

AU - Park, Sang Heum

AU - Itoi, Takao

AU - Isayama, Hiroyuki

AU - Kogure, Hirofumi

AU - Lee, Se Joon

AU - Jung, Kyo Tae

AU - Lee, Hye Sun

AU - Baron, Todd H.

AU - Lee, Dong Ki

PY - 2013/4/1

Y1 - 2013/4/1

N2 - Background: Lack of established guidelines for endoscopic papillary large balloon dilation (EPLBD) may be a reason for aversion of its use in removal of large common bile duct (CBD) stones. Aims: We sought to identify factors predictive of adverse events (AEs) following EPLBD. Methods: This multicenter retrospective study investigated 946 consecutive patients who underwent attempted removal of CBD stones ≥10 mm in size using EPLBD (balloon size 12-20 mm) with or without endoscopic sphincterotomy (EST) at 12 academic medical centers in Korea and Japan. Results: Ninety-five (10.0 %) patients exhibited AEs including bleeding in 56, pancreatitis in 24, perforation in nine, and cholangitis in six; 90 (94.7 %) of these were classified as mild or moderate in severity. There were four deaths, three as a result of perforation and one due to delayed massive bleeding. Causative factors identified in fatal cases were full-EST and continued balloon inflation despite a persistent waist seen fluoroscopically. Multivariate analyses showed that cirrhosis (OR 8.03, p = 0.003), length of EST (full-EST: OR 6.22, p < 0.001) and stone size (≥16 mm: OR 4.00, p < 0.001) were associated with increased bleeding, and distal CBD stricture (OR 17.08, p < 0.001) was an independent predictor for perforation. On the other hand, balloon size was associated with deceased pancreatitis (≥14 mm: OR 0.27, p = 0.015). Conclusions: EPLBD appears to be a safe and effective therapeutic approach for retrieval of large stones in patients without distal CBD strictures and when performed without full-EST.

AB - Background: Lack of established guidelines for endoscopic papillary large balloon dilation (EPLBD) may be a reason for aversion of its use in removal of large common bile duct (CBD) stones. Aims: We sought to identify factors predictive of adverse events (AEs) following EPLBD. Methods: This multicenter retrospective study investigated 946 consecutive patients who underwent attempted removal of CBD stones ≥10 mm in size using EPLBD (balloon size 12-20 mm) with or without endoscopic sphincterotomy (EST) at 12 academic medical centers in Korea and Japan. Results: Ninety-five (10.0 %) patients exhibited AEs including bleeding in 56, pancreatitis in 24, perforation in nine, and cholangitis in six; 90 (94.7 %) of these were classified as mild or moderate in severity. There were four deaths, three as a result of perforation and one due to delayed massive bleeding. Causative factors identified in fatal cases were full-EST and continued balloon inflation despite a persistent waist seen fluoroscopically. Multivariate analyses showed that cirrhosis (OR 8.03, p = 0.003), length of EST (full-EST: OR 6.22, p < 0.001) and stone size (≥16 mm: OR 4.00, p < 0.001) were associated with increased bleeding, and distal CBD stricture (OR 17.08, p < 0.001) was an independent predictor for perforation. On the other hand, balloon size was associated with deceased pancreatitis (≥14 mm: OR 0.27, p = 0.015). Conclusions: EPLBD appears to be a safe and effective therapeutic approach for retrieval of large stones in patients without distal CBD strictures and when performed without full-EST.

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U2 - 10.1007/s10620-012-2494-8

DO - 10.1007/s10620-012-2494-8

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AN - SCOPUS:84876694237

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JO - American Journal of Digestive Diseases

JF - American Journal of Digestive Diseases

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