Large-diameter Balloon Dilation Research Articles

Large-balloon dilation of the biliary orifice for the management of basket impaction: a case series of 6 patients

ERCP with endoscopic sphincterotomy (ES) and stone extraction remains the treatment of choice for bile duct stones 1,2 ; 85% to 90% of all CBD stones can be effectively treated by ES and stone extraction by using balloon catheters or baskets. 3 Regarding the latter devices, impaction of a Dormia basket or fracture of the basket’s traction wires during endoscopic mechanical lithotripsy with an entrapped stone in the distal CBD is an uncommon but well-known complication, 4-6 presenting a challenge to most endoscopists. Reported management strategies include the use of a mechanical lithotriptor to capture the impacted basket and crush the stone, extracorporeal shock-wave lithotripsy, endoscopic laser lithotripsy, or other sophisticated methods. 7-12 This case series describes, for the first time, the safe and effective use of large-diameter balloon dilation of the biliary orifice in the management of impacted baskets in the distal CBD.

Sa1516 Large-Diameter Balloon Dilation for the Removal of Large Common Bile Duct Stones

Sa1516 Large-Diameter Balloon Dilation for the Removal of Large Common Bile Duct Stones

New large-diameter balloon-equipped sphincterotome for removal of large bile duct stones (with videos)

Recently, endoscopic biliary sphincterotomy (EBS) followed by large-diameter balloon dilation has been used for the removal of large bile duct stones. A limitation is the need for 2 accessories: a sphincterotome and a dilating balloon. To evaluate a new device, a combination of a large-diameter dilating balloon and sphincterotome (LDDBS). Retrospective study. University hospital. Eighteen patients with large bile duct stones. After performing EBS by using the LDDBS, the catheter was then advanced into the bile duct and balloon dilation was performed by gradual inflation with diluted contrast medium under endoscopic and fluoroscopic guidance until it reached a diameter adequate to allow stone removal. Feasibility and efficacy of stone removal by using an LDDBS. Technical success of large-diameter balloon dilation after EBS was achieved in all cases. Bile duct clearance was accomplished in 94% (17/18) of cases in the first session. Bile duct clearance was eventually completed in all patients. Mechanical lithotripsy was required in 4 patients (22%). There were no major intraprocedural or postprocedural complications. Single-institution study, small sample size. The prototype LDDBS is safe and effective to facilitate the removal of large bile duct stones by using one accessory.

Endoscopic Large-Diameter Balloon Dilation after Fistulotomy for the Removal of Bile Duct Stones in a Patient with Billroth II Gastrectomy

Endoscopic Large-Diameter Balloon Dilation after Fistulotomy for the Removal of Bile Duct Stones in a Patient with Billroth II Gastrectomy

Endoscopic large-diameter balloon dilation after fistulotomy for the removal of bile duct stones in a difficult cannulation

When standard methods of biliary cannulation fail, needle-knife fistulotomy may be used. However, large stones cannot be easily extracted through the necessarily smaller opening made when using the fistulotomy technique. We report the efficacy and safety of endoscopic large-diameter balloon dilation after fistulotomy for the removal of bile duct stones in patients in whom cannulation is difficult. A case series. A tertiary referral center. Six patients (6 of 115, 5.2%) with bile duct stones in whom cannulation by the conventional method had failed underwent fistulotomy and large-diameter (12-15 mm) balloon dilation through the fistulotomy tract. Successful biliary cannulation, outcome of therapy, and post-ERCP complications including pancreatitis were recorded. Biliary cannulation was successful in 6 of 6 patients (100%) with fistulotomy. After endoscopic large-diameter balloon dilation of the fistulotomy tract, stone extraction was successfully performed in 6 of 6 patients. None of the patients developed post-ERCP pancreatitis. One of the 6 patients had minor delayed bleeding, which stopped spontaneously. A small case series, retrospective design, and no control group. Endoscopic large-diameter balloon dilation through the fistulotomy tract may be a feasible and safe alternative method for the removal of bile duct stones in patients in whom cannulation is difficult.

Commentaire de travail de S. P. Misra et al., pp. 209

See also: Large-diameter balloon dilation after endoscopic sphincterotomy for removal of difficult bile duct stonesEndoscopy 2008; 40(03): 209-213DOI: 10.1055/s-2007-967040

Large-diameter balloon dilation after endoscopic sphincterotomy for removal of difficult bile duct stones

Endoscopic sphincterotomy followed by extraction using a Dormia basket or an extraction balloon catheter is the procedure that is generally used for the removal of bile duct stones. This is not successful in all patients, however, and some stones have to be extracted using lithotripsy devices. In an attempt to avoid mechanical lithotripsy, we used large-diameter balloons after sphincterotomy for removing stones that could not be extracted using the conventional methods. In this retrospective pilot study, large-diameter (15-mm, 18-mm, or 20-mm maximum sizes) balloon dilation of the sphincterotomy site was performed in 50 patients in whom bile duct stones could not be removed by endoscopic sphincterotomy and Dormia basket or balloon catheter extraction. The stones varied in size from < 15 mm to 25 mm. Common bile duct stones could be removed in all the patients using the large-diameter balloon technique. A Dormia basket or an extraction balloon catheter was required for removal of stones in 29 patients (58 %); and mechanical lithotripsy was required in five patients (10 %). Minor oozing of blood was seen in 16 patients (32 %), but the ooze stopped spontaneously during the endoscopy. Melena occurred in two patients and major bleeding requiring surgery occurred in one patient. Mild acute pancreatitis that resolved with conservative management occurred in four patients (8 %). There were no perforations and no deaths. Large-diameter balloon dilation of the sphincterotomy site is an effective procedure for removal of bile duct stones that cannot be extracted by endoscopic sphincterotomy and conventional extraction devices. Mechanical lithotripsy could be avoided in the majority of these patients using this approach.