Repeated balloon inflation under low pressure may reduce serious adverse events during endoscopic papillary large balloon dilation

2021 ◽  
Author(s):  
Hideki Kamada ◽  
Hideki Kobara ◽  
Hiroki Yamana ◽  
Naoki Fujita ◽  
Namima Daisuke ◽  
...  
Keyword(s):  
Adverse Events ◽  
Balloon Dilation ◽  
Low Pressure ◽  
Balloon Inflation ◽  
Serious Adverse Events ◽  
Large Balloon ◽  
Large Balloon Dilation

scholarly journals Complex biliary stones management: cholangioscopy versus papillary large balloon dilation – a randomized controlled trial

2018 ◽  
Vol 06 (02) ◽  
pp. E131-E138 ◽  
Author(s):  
Tomazo Franzini ◽  
Renata Moura ◽  
Priscilla Bonifácio ◽  
Gustavo Luz ◽  
Thiago de Souza ◽  
...  
Keyword(s):  
Adverse Events ◽  
Success Rate ◽  
Balloon Dilation ◽  
Success Rates ◽  
Biliary Stones ◽  
Stone Removal ◽  
Large Balloon ◽  
Group 2 ◽  
Large Balloon Dilation ◽  
Group 1

Abstract Background and study aims Endoscopic removal of biliary stones has high success rates, ranging between 85 % to 95 %. Nevertheless, some stones may be challenging and different endoscopic methods have evolved. Papillary large balloon dilation after sphincterotomy is a widely used technique with success rates ranging from 68 to 90 % for stones larger than 15 mm. Cholangioscopy allows performing lithotripsy under direct biliary visualization, either by laser or electrohydraulic waves, which have similar success rate (80 % – 90 %). However, there is no study comparing these 2 techniques. Patients and methods From April 2014 to June 2016, 100 patients were enrolled and randomized in 2 groups, using a non-inferiority hypothesis: cholangioscopy + electrohydraulic lithotripsy (group 1) and endoscopic papillary large balloon dilation (group 2). The main outcome was complete stone removal. Adverse events were documented. Mechanical lithotripsy was not performed. Failure cases had a second session with crossover of the methods. Results The mean age was 56 years. 74 (75.5 %) patients were female. The initial overall complete stone removal rate was 74.5 % (77.1 % in group 1 and 72 % in group 2, P > 0.05). After second session the overall success rate achieved 90.1 %. Procedure time was significantly lower in group 2, – 25.2 min (CI95 % – 12.48 to – 37.91). There were no significant differences regarding technical success rate, radiologic exposure and adverse events. Conclusion Single-operator cholangioscopy-guided lithotripsy and papillary large balloon dilation are effective and safe approaches for removing complex biliary stones.

Tu1585 Does Using Balloons Larger Than 15 mm in Size Increase the Risk of Adverse Events in Endoscopic Large Balloon Dilation?

2016 ◽  
Vol 83 (5) ◽  
pp. AB616-AB617
Author(s):  
Jin Hong Kim ◽  
Min Jae Yang ◽  
Jae Chul Hwang ◽  
Byung Moo Yoo ◽  
Se-Joon Lee ◽  
...  
Keyword(s):  
Adverse Events ◽  
Balloon Dilation ◽  
Size Increase ◽  
Large Balloon ◽  
Large Balloon Dilation

Multicenter randomized trial of endoscopic papillary large balloon dilation without sphincterotomy versus endoscopic sphincterotomy for removal of bile duct stones: MARVELOUS trial

Endoscopy ◽  
2020 ◽  
Vol 52 (09) ◽  
pp. 736-744 ◽  
Author(s):  
Hirofumi Kogure ◽  
Shuhei Kawahata ◽  
Tsuyoshi Mukai ◽  
Shinpei Doi ◽  
Takuji Iwashita ◽  
...  
Keyword(s):  
Bile Duct ◽  
Adverse Events ◽  
Randomized Trial ◽  
Endoscopic Sphincterotomy ◽  
Balloon Dilation ◽  
Single Session ◽  
Stone Removal ◽  
Cbd Stones ◽  
Large Balloon ◽  
Large Balloon Dilation

Abstract Background Endoscopic papillary large balloon dilation (EPLBD) has been increasingly used for the management of large common bile duct (CBD) stones. Although EPLBD is often preceded by endoscopic sphincterotomy (EST), EPLBD alone without EST has been increasingly reported as an alternative to EST for large CBD stones. Methods This multicenter randomized trial was conducted at 19 Japanese institutions to compare the efficacy and safety of EPLBD alone versus EST for the removal of large (≥ 10 mm) CBD stones. The primary end point was complete stone removal in a single session. The secondary end points included: overall complete stone removal, lithotripsy use, procedure time, adverse events, and cost. Results 171 patients with large CBD stones were included in the analysis. The rate of single-session complete stone removal was significantly higher in the EPLBD-alone group than in the EST group (90.7 % vs. 78.8 %; P = 0.04). Lithotripsy use was significantly less frequent in the EPLBD group than in the EST group (30.2 % vs. 48.2 %; P = 0.02). The rates of early adverse events were comparable between the two groups: rates of overall adverse events were 9.3 % vs. 9.4 % and of pancreatitis were 4.7 % vs. 5.9 % in the EPLBD and EST groups, respectively. The procedure costs were $1442 vs. $1661 in the EPLBD and EST groups, respectively (P = 0.12). Conclusion EPLBD without EST for the endoscopic treatment of large CBD stones achieved a significantly higher rate of complete stone removal in a single session compared with EST, without increasing adverse events.

Mo1308 Factors Predictive of Adverse Events Following Endoscopic Papillary Large Balloon Dilation: Results From a Multicenter Series

2012 ◽  
Vol 75 (4) ◽  
pp. AB383-AB384
Author(s):  
Sung Ill Jang ◽  
Soo Jung Park ◽  
Jin Hong Kim ◽  
Jae Chul Hwang ◽  
Ho Gak Kim ◽  
...  
Keyword(s):  
Adverse Events ◽  
Balloon Dilation ◽  
Large Balloon ◽  
Large Balloon Dilation

scholarly journals Endoscopic Papillary Large Balloon Dilation Reduces the Need for Mechanical Lithotripsy in Patients with Large Bile Duct Stones: A Systematic Review and Meta-Analysis

2014 ◽  
Vol 2014 ◽  
pp. 1-8 ◽  
Author(s):  
Mohammad F. Madhoun ◽  
Sachin Wani ◽  
Sam Hong ◽  
William M. Tierney ◽  
John T. Maple
Keyword(s):  
Bile Duct ◽  
Adverse Events ◽  
Fixed Effects ◽  
Balloon Dilation ◽  
Bile Duct Stones ◽  
Stone Clearance ◽  
Mechanical Lithotripsy ◽  
Large Balloon ◽  
Large Balloon Dilation ◽  
Large Bile Duct

Background. Removal of large stones can be challenging and frequently requires the use of mechanical lithotripsy (ML). Endoscopic papillary large balloon dilation (EPLBD) following endoscopic sphincterotomy (ES) is a technique that appears to be safe and effective. However, data comparing ES + EPLBD with ES alone have not conclusively shown superiority of either technique. Objective. To assess comparative efficacies and rate of adverse events of these methods. Method. Studies were identified by searching nine medical databases for reports published between 1994 and 2013, using a reproducible search strategy. Only studies comparing ES and ES + EPLBD with regard to large bile duct stone extraction were included. Pooling was conducted by both fixed-effects and random-effects models. Risk ratio (RR) estimates with 95% confidence interval (CI) were calculated. Results. Seven studies (involving 902 patients) met the inclusion criteria; 3 of 7 studies were prospective trials. Of the 902 patients, 463 were in the ES + EPLBD group, whereas 439 underwent ES alone. There were no differences noted between the groups with regard to overall stone clearance (98% versus 95%, RR  =  1.01 [0.97, 1.05]; P =0.60) and stone clearance at the 1st session (87% versus 79%, RR = 1.11 [0.98, 1.25]; P =0.11). ES + EPLBD was associated with a reduced need for ML compared to ES alone (15% versus 32%; RR  =  0.49 [0.32, 0.74]; P = 0.0008) and was also associated with a reduction in the overall rate of adverse events (11% versus 18%; RR = 0.58 [0.41, 0.81]; P =0.001). Conclusions. ES + EPLBD has similar efficacy to ES alone while significantly reducing the need for ML. Further, ES + EPLBD appears to be safe, with a lower rate of adverse events than traditional ES. ES + EPLBD should be considered as a first-line technique in the management of large bile duct stones.

scholarly journals Comparison of endoscopic papillary large balloon dilation with or without endoscopic sphincterotomy for the treatment of large bile duct stones

Endoscopy ◽  
2018 ◽  
Vol 51 (02) ◽  
pp. 125-132 ◽  
Author(s):  
Jin-Seok Park ◽  
Seok Jeong ◽  
Dong Lee ◽  
Sung Jang ◽  
Tae Lee ◽  
...  
Keyword(s):  
Bile Duct ◽  
Adverse Events ◽  
Balloon Dilation ◽  
Bile Duct Stones ◽  
Therapeutic Outcomes ◽  
Total Procedure Time ◽  
Large Balloon ◽  
Large Balloon Dilation ◽  
Large Bile Duct ◽  
Total Procedure

Abstract Background Endoscopic papillary large balloon dilation (EPLBD) without prior endoscopic sphincterotomy (EST) produces excellent outcomes for the treatment of large common bile duct (CBD) stones. However, it remains unclear how the outcomes of EPLBD alone compare with those of EPLBD with EST. In this study, we assessed the safety and therapeutic outcomes of EPLBD with vs. without EST for the removal of large bile duct stones. Methods This prospective, multicenter study was conducted on 200 patients with bile duct stones of ≥ 10 mm in diameter. Patients were randomly assigned to an EPLBD alone group (n = 100) or an EPLBD with EST group (n = 100). These two groups were compared with respect to overall procedure-related adverse events, overall stone removal success rate, number of endoscopic sessions required for complete stone removal, need for mechanical lithotripsy, and total procedure time. Results The incidence of adverse events was not significantly different between the groups (EPLBD alone vs. EPLBD with EST: overall adverse events 6 % vs. 4 %, P = 0.75; pancreatitis 1 % vs. 3 %, P = 0.62). Overall success (P = 0.35), initial success (P = 0.28), and the need for mechanical lithotripsy (P = 0.39) were also similar between groups. Median total procedure time tended to be greater in the EPLBD alone group (20.5 minutes) than in the EPLBD with EST group (18 minutes; P = 0.08). Conclusion The therapeutic outcomes and adverse events of EPLBD alone for the removal of large bile duct stones were comparable to those of EPLBD with EST.

Factors Predictive of Adverse Events Following Endoscopic Papillary Large Balloon Dilation: Results from a Multicenter Series

2012 ◽  
Vol 58 (4) ◽  
pp. 1100-1109 ◽  
Author(s):  
Soo Jung Park ◽  
Jin Hong Kim ◽  
Jae Chul Hwang ◽  
Ho Gak Kim ◽  
Don Haeng Lee ◽  
...  
Keyword(s):  
Adverse Events ◽  
Balloon Dilation ◽  
Large Balloon ◽  
Large Balloon Dilation
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