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Sato Y, Okano N, Hoshi K, Iwata S, Kimura Y, Iwasaki S, Takuma K, Igarashi Y, Matsuda T. Perforation of the bile duct caused by endoscopic papillary large balloon dilation: A case report. DEN OPEN 2025; 5:e70015. [PMID: 39323617 PMCID: PMC11422616 DOI: 10.1002/deo2.70015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/08/2024] [Revised: 09/03/2024] [Accepted: 09/05/2024] [Indexed: 09/27/2024]
Abstract
The patient was a woman in her 70s with multiple large biliary stones. Lithotripsy was attempted after endoscopic papillary large balloon dilatation. During balloon dilation, inflator resistance, and body movement due to patient pain were observed, and maximum pressure was required for the disappearance of the balloon waist. A bile duct perforation was observed when the balloon was deflated. Computed tomography after endoscopic retrograde cholangiopancreatography showed free air from the duodenal peritoneum to the right retroperitoneum. The patient was conservatively treated with nasobiliary drainage. Endoscopic large balloon dilatation is useful for large bile duct stones that are difficult to remove using endoscopic sphincterotomy alone or endoscopic papillary balloon dilation. Perforation is a potentially fatal adverse event; therefore, imaging of the intrapancreatic bile ducts should be performed before endoscopic retrograde cholangiopancreatography and attention should be paid to the balloon dilation method.
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Affiliation(s)
- Yoichiro Sato
- Department of Gastroenterology and HepatologyToho University Omori Medical CenterTokyoJapan
| | - Naoki Okano
- Department of Gastroenterology and HepatologyToho University Omori Medical CenterTokyoJapan
| | - Kensuke Hoshi
- Department of Gastroenterology and HepatologyToho University Omori Medical CenterTokyoJapan
| | - Shuntaro Iwata
- Department of Gastroenterology and HepatologyToho University Omori Medical CenterTokyoJapan
| | - Yusuke Kimura
- Department of Gastroenterology and HepatologyToho University Omori Medical CenterTokyoJapan
| | - Susumu Iwasaki
- Department of Gastroenterology and HepatologyToho University Omori Medical CenterTokyoJapan
| | - Kensuke Takuma
- Department of Gastroenterology and HepatologyToho University Omori Medical CenterTokyoJapan
| | - Yoshinori Igarashi
- Department of Gastroenterology and HepatologyToho University Omori Medical CenterTokyoJapan
| | - Takahisa Matsuda
- Department of Gastroenterology and HepatologyToho University Omori Medical CenterTokyoJapan
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Zhou F, Zhan X, Hu D, Wu N, Hong J, Li G, Chen Y, Zhou X. Evaluation of ERCP-related perforation: a single-center retrospective study. Gastroenterol Rep (Oxf) 2024; 12:goae044. [PMID: 38766494 PMCID: PMC11099543 DOI: 10.1093/gastro/goae044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 02/05/2024] [Accepted: 04/14/2024] [Indexed: 05/22/2024] Open
Abstract
Background Endoscopic retrograde cholangiopancreatography (ERCP)-related perforation is a rare and serious adverse event. The aim of our study was to evaluate the risk factors and management of ERCP-related perforation, and to further determine the predictive factors associated with perforation outcome. Methods A total of 27,018 ERCP procedures performed at the First Affiliated Hospital of Nanchang University (Nanchang, China) between January 2007 and March 2022 were included in the investigation of ERCP-related perforation. Medical records and endoscopic data were extracted to analyse the risk factors, management, and clinical outcome of ERCP-related perforation. Results Seventy-six patients (0.28%) were identified as having experienced perforation following ERCP. Advanced age, Billroth II anatomy, precut sphincterotomy, and papillary balloon dilatation were significantly associated with ERCP-related perforation. Most patients with perforation (n = 65) were recognized immediately during ERCP whereas 11 were recognized later on. The delay in recognition primarily resulted from stent migration (n = 9). In addition, 12 patients experienced poor clinical outcome including death or hospice discharge (n = 3), ICU admission for >3 days (n = 6), and prolonged hospital stay for >1 month due to perforation (n = 3). Cancer and systemic inflammatory response syndrome (SIRS) are associated with a higher risk of poor outcome. Conclusions Advanced age, Billroth II anatomy, precut sphincterotomy, and balloon dilation increase the risk of ERCP-related perforation whereas cancer and SIRS independently predicted poor clinical outcome.
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Affiliation(s)
- Feng Zhou
- Department of Gastroenterology, Digestive Disease Hospital, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, P. R. China
| | - Xiaoyun Zhan
- Department of Gastroenterology, The Third Hospital of Nanchang, Nanchang, Jiangxi, P. R. China
| | - Dan Hu
- Department of Gastroenterology, Digestive Disease Hospital, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, P. R. China
| | - Nanzhen Wu
- Department of Gastrointestinal Surgery, Fengcheng People's Hospital, Fengcheng, Jiangxi, P. R. China
| | - Junbo Hong
- Department of Gastroenterology, Digestive Disease Hospital, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, P. R. China
| | - Guohua Li
- Department of Gastroenterology, Digestive Disease Hospital, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, P. R. China
| | - Youxiang Chen
- Department of Gastroenterology, Digestive Disease Hospital, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, P. R. China
| | - Xiaojiang Zhou
- Department of Gastroenterology, Digestive Disease Hospital, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, P. R. China
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Feng Y, Liang Y, Liu Y, Zhang Y, Huang S, Ren L, Ma X, Zhou A, Shi R. Digital cholangioscopy-assisted, direct visualization-guided, radiation-free, endoscopic retrograde intervention for cholelithiasis: technical feasibility, efficacy, and safety. Surg Endosc 2024; 38:1637-1646. [PMID: 38286835 DOI: 10.1007/s00464-024-10684-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 01/02/2024] [Indexed: 01/31/2024]
Abstract
BACKGROUND Nonradiation, digital cholangioscope (DCS)-assisted endoscopic intervention for cholelithiasis has not been widely performed. For this study, we aimed to report the feasibility, efficacy, and safety of an established DCS-guided lithotomy procedure. METHODS Data relating to biliary exploration, stone clearance, adverse events, and follow-up were obtained from 289 patients. The choledocholithiasis-related outcomes via the DCS-guided procedure were subsequently compared to those via conventional endoscopic retrograde cholangiopancreatography (ERCP). RESULTS Biliary access was achieved in 285 patients. The technical success rate for the exploration of the common bile duct, the cystic stump, the hilar ducts, and secondary radicals was 100%. Moreover, the success rates were 98.4%, 61.7%, and 20.7%, for the exploration of the cystic duct, complete cystic duct, and gallbladder, respectively. Suspicious or confirmed suppurative cholecystitis, cholesterol polyps, and hyperplastic polyps were detected in 42, 23, and 5 patients, respectively. Stone clearance was achieved in one session in 285 (100%), 11 (100%), 13 (100%), 7 (100%), 6 (100%), and 3 (14.3%) patients with choledocholithiasis and hepatolithiasis, cystic duct stump stones, nondiffuse located intrahepatic lithiasis, a single cystic duct stone, a single gallbladder stone, and diffuse located intrahepatic lithiasis, respectively. Complete stone clearance for diffuse intrahepatic lithiasis was achieved in 19 (90.5%) patients, and fractioned re-lithotomy was performed in 16 (76.2%) patients. One patient developed mild acute cholangitis, and 12 developed mild pancreatitis. Stones recurred in one patient. Compared with conventional ERCP, DCS-guided lithotomy has the advantages of clearing difficult-to-treat choledocholithiasis and revealing concomitant biliary lesions, and this technique has fewer complications and a decreased risk of stone recurrence. CONCLUSIONS The technical profile, efficacy, and safety of nonradiation-guided and DCS-guided lithotomy are shown in this study. We provide a feasible modality for the endoscopic removal of cholelithiasis.
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Affiliation(s)
- Yadong Feng
- Department of Gastroenterology, School of Medicine, Zhongda Hospital Southeast University, Southeast University, 87 Dingjiaqiao Road, Nanjing, 210009, China.
- Department of Gastroenterology, Lianshui People's Hospital, 6 Hongri Road, Lianshui, 223400, China.
| | - Yan Liang
- Department of Gastroenterology, School of Medicine, Zhongda Hospital Southeast University, Southeast University, 87 Dingjiaqiao Road, Nanjing, 210009, China
| | - Yang Liu
- Department of Gastroenterology, School of Medicine, Zhongda Hospital Southeast University, Southeast University, 87 Dingjiaqiao Road, Nanjing, 210009, China
| | - Yinqiu Zhang
- Department of Gastroenterology, Previously School of Medicine, Humanity Hospital, Southeast University, 3777 Yuexian Road, Xiamen, 361006, China
| | - Shuaijing Huang
- Department of Gastroenterology, School of Medicine, Zhongda Hospital Southeast University, Southeast University, 87 Dingjiaqiao Road, Nanjing, 210009, China
| | - Lihua Ren
- Department of Gastroenterology, School of Medicine, Zhongda Hospital Southeast University, Southeast University, 87 Dingjiaqiao Road, Nanjing, 210009, China
| | - Xiaojun Ma
- Department of Translational Research, Nanjing Microtech Medical Technology Co. Ltd., 10 Gaoke 3rd Road, Nanjing, 210018, China
| | - Aijun Zhou
- Department of Gastroenterology, Lianshui People's Hospital, 6 Hongri Road, Lianshui, 223400, China.
| | - Ruihua Shi
- Department of Gastroenterology, School of Medicine, Zhongda Hospital Southeast University, Southeast University, 87 Dingjiaqiao Road, Nanjing, 210009, China.
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