Clinical Endoscopy

Original Article

Risk factors for recurrent stenosis after balloon dilation for benign hepaticojejunostomy anastomotic stricture: Takafumi Mie, Takashi Sasaki, Takeshi Okamoto, Tsuyoshi Takeda, Chinatsu Mori, Yuto Yamada, Takaaki Furukawa, Akiyoshi Kasuga, Masato Matsuyama, Masato Ozaka, Naoki Sasahira; Clin Endosc 2024;57(2):253-262. Published online May 16, 2023; DOI: https://doi.org/10.5946/ce.2022.216

Graphical Abstract Abstract PDF PubReader ePub: Background
/Aims: Hepaticojejunostomy anastomotic stricture (HJAS) is a feared adverse event associated with hepatopancreatobiliary surgery. Although balloon dilation for benign HJAS during endoscopic retrograde cholangiopancreatography with balloon-assisted enteroscopy has been reported to be useful, the treatment strategy remains controversial. Therefore, we evaluated the outcomes and risk factors of recurrent stenosis after balloon dilation alone for benign HJAS.
Methods
We retrospectively analyzed consecutive patients who underwent balloon-assisted enteroscopy–endoscopic retrograde cholangiopancreatography for benign HJAS at our institution between July 2014 and December 2020.
Results
Forty-six patients were included, 16 of whom had recurrent HJAS after balloon dilation. The patency rates at 1 and 2 years after balloon dilation were 76.8% and 64.2%, respectively. Presence of a residual balloon notch during balloon dilation was an independent predictor of recurrence (hazard ratio, 2.80; 95% confidence interval, 1.01–7.78; p=0.048), whereas HJAS within postoperative 1 year tended to be associated with recurrence (hazard ratio, 2.43; 95% confidence interval, 0.85–6.89; p=0.096). The patency rates in patients without a residual balloon notch were 82.1% and 73.1% after 1 and 2 years, respectively.
Conclusions
Balloon dilation alone may be a viable option for patients with benign HJAS without residual balloon notches on fluoroscopy.

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Systematic Review and Meta-Analysis

Stent versus Balloon Dilation for the Treatment of Dominant Strictures in Primary Sclerosing Cholangitis: A Systematic Review and Meta-Analysis: Marina Tucci Gammaro Baldavira Ferreira, Igor Braga Ribeiro, Diogo Turiani Hourneaux de Moura, Thomas R. McCarty, Alberto Machado da Ponte Neto, Galileu Ferreira Ayala Farias, Antônio Afonso de Miranda Neto, Pedro Victor Aniz Gomes de Oliveira, Wanderley Marques Bernardo, Eduardo Guimarães Hourneaux de Moura; Clin Endosc 2021;54(6):833-842. Published online July 1, 2021; DOI: https://doi.org/10.5946/ce.2021.052

Abstract PDF PubReader ePub

Background
/Aims: The endoscopic management of primary sclerosing cholangitis (PSC)-associated dominant strictures remains challenging. This systematic review and meta-analysis aimed to compare balloon dilation and stent placement in the treatment of dominant strictures among PSC patients.
Methods
Literature searches on MEDLINE, EMBASE, Cochrane CENTRAL and Lilacs/Bireme were performed for studies published until December 2020. Measured outcomes included clinical efficacy, stricture recurrence, cumulative recurrencefree rate, transplant rate, 5-year survival rate, and adverse events (i.e., pancreatitis, cholangitis, bleeding, perforation and death).
Results
A total of 5 studies (n=467) were included. Based on pooled analyses, there were no differences in clinical efficacy (risk difference [RD], -0.13; 95% confidence interval [CI], -0.58 to 0.33; I²=93%) or transplant rates (RD, -0.09; 95% CI, -0.19 to 0.01; I²=0%); however, the risk of occurrence of adverse events was lower with balloon dilatation than with stent placement (RD,-0.34; 95% CI, -0.45 to -0.23; I²=61%). Among the types of adverse events reported, only the rates of cholangitis/bacteremia were significantly lower in balloon dilation patients (RD, -0.19; 95% CI, -0.25 to -0.13; I²=51%).
Conclusions
Compared to balloon dilation, stent placement for dominant strictures in PSC appeared to have higher complication rates without significant differences in efficacy.

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Focused Review Series: Current Status of Endoscopy in the Management of Inflammatory Bowel Disease

Endoscopic Balloon Dilation for Crohn’s Disease-Associated Strictures: Thomas Klag, Jan Wehkamp, Martin Goetz; Clin Endosc 2017;50(5):429-436. Published online September 29, 2017; DOI: https://doi.org/10.5946/ce.2017.147

Abstract PDF PubReader ePub

Management of intestinal strictures associated with Crohn’s disease (CD) is clinically challenging despite advanced medical therapy directed toward mucosal healing to positively influence the natural course of CD-associated complications. Although medical therapy is available for inflammatory strictures, therapy of fibrostenotic strictures is the domain of surgery and endoscopy. Endoscopic balloon dilation (EBD) has been recognized as a well-established first-line procedure in terms of safety and efficacy. Although surgery is a valuable treatment modality for the management of CD-related strictures, EBD can help prevent multiple surgical interventions, which might in the long-term lead to a risk of short bowel syndrome. In this review we discuss requirements, techniques, safety, short- and long-term outcomes, as well as combinations of this procedure with surgical and medical treatment in CD-associated intestinal strictures.

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Gaetano Coppola, Chiara Principessa, Federica Di Vincenzo, Pierluigi Puca, Angelo Del Gaudio, Ivan Capobianco, Bianca Bartocci, Alfredo Papa, Giovanni Cammarota, Loris Riccardo Lopetuso, Franco Scaldaferri
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Alexander Worix, Rajesh N. Keswani
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Leo Fawaz, Yousif Slim, Peter N. Freswick
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Original Articles

Efficacy and Safety of Endoscopic Papillary Balloon Dilation Using Cap-Fitted Forward-Viewing Endoscope in Patients Who Underwent Billroth II Gastrectomy: Jong Soon Jang, Seungho Lee, Hee Seung Lee, Myeong Ho Yeon, Joung-Ho Han, Soon Man Yoon, Hee Bok Chae, Sei Jin Youn, Seon Mee Park; Clin Endosc 2015;48(5):421-427. Published online September 30, 2015; DOI: https://doi.org/10.5946/ce.2015.48.5.421

Abstract PDF PubReader ePub

Background/Aims

Endoscopic exploration of the common bile duct (CBD) is difficult and dangerous in patients with Billroth II gastrectomy (B-II). Endoscopic papillary balloon dilation (EPBD) via a cap-fitted forward-viewing endoscope has been reported to be an effective and safe procedure. We analyzed the technical success and complications of EPBD in patients who underwent B-II.

Methods

Thirty-six consecutive patients with B-II were enrolled from among 2,378 patients who had undergone endoscopic retrograde cholangiopancreatography in a single institute in the last 4 years. The EPBD procedure was carried out using a cap-fitted forward-viewing endoscope with 8-mm balloon catheters for 60 seconds. We analyzed the rates of CBD exploration, technical success, and complications.

Results

Afferent loop intubation was performed in all patients and selective cannulation of the bile duct was performed in 32 patients (88.9%). Complications such as transient hypoxia were observed in two patients (5.6%) and perforation, in three patients (9.7%). The perforation sites were ductal injury in two patients and one patient showed retroperitoneal air alone without symptoms. Three patients manifested different clinical courses of severe acute pancreatitis and peritonitis, transient abdominal pain, and retroperitoneal air alone. The condition of one patient improved with surgery and that of the other two patients, with conservative management.

Conclusions

Patients with perforation during EPBD in B-II showed different clinical courses. Tailored treatment strategies are necessary for improving the clinical outcomes.

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A “One Accessory and One Guidewire-in-One Channel” Technique in a Patient with Billroth II Anastomosis
Kook Hyun Kim, Sung Bum Kim, Tae Nyeun Kim
Clinical Endoscopy.2021; 54(1): 139. CrossRef
Which scope is appropriate for endoscopic retrograde cholangiopancreatography after Billroth II reconstruction: An esophagogastroduodenoscope or a colonoscope?
Mitsuru Sugimoto, Tadayuki Takagi, Rei Suzuki, Naoki Konno, Hiroyuki Asama, Yuki Sato, Hiroki Irie, Ko Watanabe, Jun Nakamura, Hitomi Kikuchi, Mika Takasumi, Minami Hashimoto, Tsunetaka Kato, Takuto Hikichi, Hiromasa Ohira
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Recent advances in endoscopic retrograde cholangiopancreatography in Billroth II gastrectomy patients: A systematic review
Tae Young Park, Tae Jun Song
World Journal of Gastroenterology.2019; 25(24): 3091. CrossRef
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Rabbinu Rangga Pribadi, Abdul Aziz Rani, Murdani Abdullah
Journal of Digestive Diseases.2019; 20(12): 631. CrossRef
Endoscopic retrograde cholangiopancreatography in Billroth II gastrectomy patients: Outcomes and potential factors affecting technical failure
Jia-Su Li, Duo-Wu Zou, Zhen-Dong Jin, Jie Chen, Xin-Gang Shi, Zhao-Shen Li, Feng Liu
Saudi Journal of Gastroenterology.2019; 25(6): 355. CrossRef
Endoscopic Management of Difficult Bile Duct Stones
Murad Aburajab, Kulwinder Dua
Current Gastroenterology Reports.2018;[Epub] CrossRef
Forward-viewing endoscope for ERCP in patients with Billroth II gastrectomy: a systematic review and meta-analysis
Tae Young Park, Chang Seok Bang, Sang Hyeon Choi, Young Joo Yang, Suk Pyo Shin, Ki Tae Suk, Gwang Ho Baik, Dong Joon Kim, Jai Hoon Yoon
Surgical Endoscopy.2018; 32(11): 4598. CrossRef
Self-expandable metal stents for choledocholithiasis in Billroth II gastrectomy patients
Min-Gui Han, Eunae Cho, Chang-Hwan Park, Chung-Hwan Jun, Seon-Young Park
Hepatobiliary & Pancreatic Diseases International.2018; 17(6): 546. CrossRef
Recent Advanced Endoscopic Management of Endoscopic Retrograde Cholangiopancreatography Related Duodenal Perforations
Seon Mee Park
Clinical Endoscopy.2016; 49(4): 376. CrossRef

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Late Complications and Stone Recurrence Rates after Bile Duct Stone Removal by Endoscopic Sphincterotomy and Large Balloon Dilation are Similar to Those after Endoscopic Sphincterotomy Alone: Ka Young Kim, Jimin Han, Ho Gak Kim, Byeong Suk Kim, Jin Tae Jung, Joong Goo Kwon, Eun Young Kim, Chang Hyeong Lee; Clin Endosc 2013;46(6):637-642. Published online November 19, 2013; DOI: https://doi.org/10.5946/ce.2013.46.6.637

Abstract PDF PubReader ePub

Background/Aims

Between endoscopic sphincterotomy (ES) alone and combined endoscopic sphincterotomy and large balloon dilation (ES-LBD) groups, efficacy and long-term complications, difference in biliary stone recurrence rate, and risk factors of stone recurrence were compared.

Methods

Medical records of 222 patients who underwent ERCP for biliary stone removal were retrospectively reviewed. Patients with dilated CBD ≥11 mm and follow-up longer than 6 months were included.

Results

There were 101 patients in ES-LBD group and 121 patients in ES group. Mean follow-up duration was 25.0 (6-48) months and 13.0 (6-43) months, respectively (p=0.001). There was no difference in number of ERCP sessions, brown pigment stones, angle between mid and distal common bile duct (CBD angle) <135°, and lithotripsy rate. Complete retrieval success rate was excellent in both groups (100% vs. 99%). Early complication rate of ES-LBD and ES alone group was 4 and 4.1%, respectively (p=1.000). One patient in ES-LBD group died from delayed bleeding. Late complication rate was 5.9 and 3.3%, respectively (p=1.000). Stone recurrence rate was 6.9% and 5.8%, respectively (p=0.984). The only Independent risk factor of stone recurrence was presence of periampullary diverticulum.

Conclusions

Late complication and stone recurrence rates were similar between ES-LBD and ES alone groups.

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Digestive Endoscopy.2018; 30(3): 293. CrossRef
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Tatenda C. Nzenza, Yahya Al-Habbal, Glen R. Guerra, S. Manolas, Tuck Yong, Trevor McQuillan
BMC Gastroenterology.2018;[Epub] CrossRef
Comparison of late adverse events after endoscopic sphincterotomy versus endoscopic papillary large balloon dilation for common bile duct stones: A propensity score‐based cohort analysis
Akinori Maruta, Takuji Iwashita, Shinya Uemura, Kensaku Yoshida, Keisuke Iwata, Tsuyoshi Mukai, Shinpei Doi, Ichiro Yasuda, Kenji Imai, Masahito Shimizu
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Tao Li, Jun Wen, Like Bie, Biao Gong
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Gregorios A. Paspatis, Konstantina Paraskeva, Emmanouil Vardas, Vasilios Papastergiou, Aikaterini Tavernaraki, Maria Fragaki, Angeliki Theodoropoulou, Gregorios Chlouverakis
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Jian-Shan Cai, Sun Qiang, Yin Bao-Bing
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Endoscopic Papillary Large Balloon Dilatation Without Sphincterotomy for the Treatment of Large Common Bile Duct Stone: Long-Term Outcomes at a Single Center
Jin-Seok Park, Seok Jeong, Byung Wook Bang, Ae Ra Kang, Don Haeng Lee
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Yasunobu Yamashita, Kazuki Ueda, Yuki Kawaji, Takashi Tamura, Masahiro Itonaga, Takeichi Yoshida, Hiroki Maeda, Hirohito Magari, Takao Maekita, Mikitaka Iguchi, Hideyuki Tamai, Masao Ichinose, Jun Kato
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Yi Lu, Jia-Chuan Wu, Lei Liu, Li-Ke Bie, Biao Gong
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Long-Term Outcome of Endoscopic Papillary Large Balloon Dilatation
Chang-Il Kwon
Clinical Endoscopy.2013; 46(6): 601. CrossRef

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Focused Review Series: A Perspective: Endoscopy and Imaging in Inflammatory Bowel Disease

Small Bowel Endoscopy in Inflammatory Bowel Disease: Hirokazu Yamagami, Kenji Watanabe, Noriko Kamata, Mitsue Sogawa, Tetsuo Arakawa; Clin Endosc 2013;46(4):321-326. Published online July 31, 2013; DOI: https://doi.org/10.5946/ce.2013.46.4.321

Abstract PDF PubReader ePub

Crohn disease (CD) is a chronic inflammatory bowel disease that affects the entire gastrointestinal tract but is most frequently localized to the large and small bowel. Small bowel endoscopy helps with the differential diagnosis of CD in suspected CD patients. Early diagnosis of CD is preferable for suspected CD conditions to improve chronic inflammatory infiltrates, fibrosis. Small bowel endoscopy can help with the early detection of active disease, thus leading to early therapy before the onset of clinical symptoms of established CD. Some patients with CD have mucosal inflammatory changes not in the terminal ileum but in the proximal small bowel. Conventional ileocolonoscopy cannot detect ileal involvement proximal to the terminal ileum. Small bowel endoscopy, however, can be useful for evaluating these small bowel involvements in patients with CD. Small bowel endoscopy by endoscopic balloon dilation (EBD) enables the treatment of small bowel strictures in patients with CD. However, many practical issues still need to be addressed, such as endoscopic findings for early detection of CD, application compared with other imaging modalities, determination of the appropriate interval for endoscopic surveillance of small bowel lesions in patients with CD, and long-term prognosis after EBD.

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DEN Open.2022;[Epub] CrossRef
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Laura Ramos López, Alejandro Hernández Camba, Iago Rodríguez-Lago, Marta Carrillo Palau, Luis Cejas Dorta, Ainara Elorza, Inmaculada Alonso Abreu, Milagros Vela, Alba Hidalgo, Noemi Hernández Álvarez-Builla, G. Esther Rodríguez, Yolanda Rodríguez, Carlos
Gastroenterología y Hepatología.2020; 43(8): 439. CrossRef
Usefulness of magnetic resonance enterography in the clinical decision-making process for patients with inflammatory bowel disease
Laura Ramos López, Alejandro Hernández Camba, Iago Rodríguez-Lago, Marta Carrillo Palau, Luis Cejas Dorta, Ainara Elorza, Inmaculada Alonso Abreu, Milagros Vela, Alba Hidalgo, Noemi Hernández Álvarez-Builla, G. Esther Rodríguez, Yolanda Rodríguez, Carlos
Gastroenterología y Hepatología (English Edition).2020; 43(8): 439. CrossRef
Different clinical outcomes in Crohn’s disease patients with esophagogastroduodenal, jejunal, and proximal ileal disease involvement: is L4 truly a single phenotype?
Ren Mao, Rui-Han Tang, Yun Qiu, Bai-Li Chen, Jing Guo, Sheng-Hong Zhang, Xue-Hua Li, Rui Feng, Yao He, Zi-Ping Li, Zhi-Rong Zeng, Rami Eliakim, Shomron Ben-Horin, Min-Hu Chen
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Special Issue Articles of IDEN 2012

Endoscopic Papillary Large Balloon Dilation: Guidelines for Pursuing Zero Mortality: Dong Ki Lee, Jung Woo Han; Clin Endosc 2012;45(3):299-304. Published online August 22, 2012; DOI: https://doi.org/10.5946/ce.2012.45.3.299

Abstract PDF PubReader ePub

Since endoscopic papillary large balloon dilation (EPLBD) is used to treat benign disease and as a substitute for conventional methods, such as endoscopic sphincterotomy plus endoscopic mechanical lithotripsy, we should aim for zero mortality. This review defines EPLBD and suggests guidelines for its use based on a review of published articles and our large-scale multicenter retrospective review.

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Perforation of the bile duct caused by endoscopic papillary large balloon dilation: A case report
Yoichiro Sato, Naoki Okano, Kensuke Hoshi, Shuntaro Iwata, Yusuke Kimura, Susumu Iwasaki, Kensuke Takuma, Yoshinori Igarashi, Takahisa Matsuda
DEN Open.2025;[Epub] CrossRef
Endoscopic Papillary Large Balloon Dilatation With or Without Endoscopic Sphincterotomy in the Treatment of Common Bile Duct Stones
Jia Wang, Lichao Cao, Kuijin Xue, Peng Qi, Qingdong Mao, Mingjuan Cui, Hui Ju, Baoguo He, Bin Cao
Digestive Diseases and Sciences.2025; 70(2): 478. CrossRef
Endoscopic Papillary Large Balloon Dilatation (EPLBD) for the Extraction of Common Bile Duct Stones (CBDS).
Mohamed Alsenbesy, Khaled Shahat, Abdallah Nawara, Mohammad Sallam, Mohamed Fakhry, Mohamed Shazly, Mohamed Moussa, Mohammed Tag-Adeen, Hussein El-Amin, Mohammed Sobh
Revista Española de Enfermedades Digestivas.2019;[Epub] CrossRef
Endoscopic Papillary Balloon Dilation/Endoscopic Papillary Large Balloon Dilation
Seok Jeong
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Tzung-Jiun Tsai, Chiun-Ku Lin, Kwok-Hung Lai, Hoi-Hung Chan, E-Ming Wang, Wei-Lun Tsai, Jin-Shiung Cheng, Hsien-Chung Yu, Wen-Chi Chen, Ping-I Hsu
Journal of the Chinese Medical Association.2018; 81(4): 311. CrossRef
Japan Gastroenterological Endoscopy Society guidelines for endoscopic papillary large balloon dilation
Takao Itoi, Shomei Ryozawa, Akio Katanuma, Yoshinobu Okabe, Hironori Kato, Jun Horaguchi, Takayoshi Tsuchiya, Takuji Gotoda, Naotaka Fujita, Kenjiro Yasuda, Yoshinori Igarashi, Kazuma Fujimoto
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Tae Hyeon Kim, Jin Hong Kim, Dong Wan Seo, Dong Ki Lee, Nageshwar D. Reddy, Rungsun Rerknimitr, Thawee Ratanachu-Ek, Christopher J.L. Khor, Takao Itoi, Ichiro Yasuda, Hiroyuki Isayama, James Y.W. Lau, Hsiu-Po Wang, Hoi-Hung Chan, Bing Hu, Richard A. Kozar
Gastrointestinal Endoscopy.2016; 83(1): 37. CrossRef
Efficacy and Safety of Endoscopic Papillary Large Balloon Dilation for Removal of Large Bile Duct Stones in Advanced Age
Kook Hyun Kim, Tae Nyeun Kim
Canadian Journal of Gastroenterology and Hepatology.2016; 2016: 1. CrossRef
Tips in biliary stone removal using endoscopic papillary large balloon dilation
Anthony Yuen Bun Teoh, James Yun Wong Lau
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Fumihide Itokawa, Takao Itoi, Atsushi Sofuni, Toshio Kurihara, Takayoshi Tsuchiya, Kentaro Ishii, Shujiro Tsuji, Nobuhito Ikeuchi, Junko Umeda, Reina Tanaka, Ryosuke Tonozuka, Mitsuyoshi Honjyo, Fuminori Moriyasu, Kazuhiko Kasuya, Akihiko Tsuchida
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The Efficacy of Endoscopic Papillary Balloon Dilation for Patients with Acute Biliary Pancreatitis
Wei-Chih Sun, Hoi-Hung Chan, Kwok-Hung Lai, Tzung-Jiun Tsai, Huey-Shyan Lin, Kung-Hung Lin, Kai-Ming Wang, Sung-Shuo Kao, Po-Hung Chiang, Jin-Shiung Cheng, Ping-I Hsu, Wei-Lun Tsai, Wen-Chi Chen, Yun-Da Li, E-Ming Wang
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Which Is the Better Treatment for the Removal of Large Biliary Stones? Endoscopic Papillary Large Balloon Dilation versus Endoscopic Sphincterotomy
Woo Hyun Paik, Ji Kon Ryu, Jin Myung Park, Byeong Jun Song, Jaihwan Kim, Joo Kyung Park, Yong-Tae Kim
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Korean Journal of Pancreas and Biliary Tract.2014; 19(2): 94. CrossRef
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Sung Ill Jang
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Duk Joo Choi, Yeon Suk Kim, Jung Ho Kim, Yang Suh Ku, Min Su Ha, Ju Hyeon Kim
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Seok Ho Dong
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A Case of a Cytomegalovirus Colitis Related Rectal Stricture Treated by Endoscopic Balloon Dilation: Kwonoh Park, M.D., Kyung Ho Kim, M.D., Jong Won Park, M.D., Sangho Lee, M.D., Hyunjung Jo, M.D., Seungyun Chun, M.D., Hyewon Park, M.D. and Hak Yang Kim, M.D.; Korean J Gastrointest Endosc 2010;41(4):240-244. Published online October 30, 2010

Abstract PDF: Cytomegalovirus (CMV) colitis is a common opportunistic infection in immunocompromised patients. Affected individuals present with abdominal pain, diarrhea, or hematochezia. Complications of CMV colitis can include massive bleeding, toxic megacolon, bowel perforation and, rarely, colon stricture. A 69-year-old woman who had no specific past history was admitted to the orthopedic department for pelvic bone fracture with right iliac artery rupture caused by a traffic accident. She was successfully managed with emergency transarterial coil embolization. After 2 weeks, she developed hematochezia and recurrent abdominal pain. Colonoscopy showed a huge, deep ulcer in the rectosigmoid colon. Biopsy and immunohistochemical staining revealed giant cells with intracellular inclusion bodies that were positive for CMV antigen. She received antiviral treatment after which her symptoms improved. On follow-up colonoscopy 3 months later, we found a tight luminal narrowing in the rectum. We did a repeat endoscopic balloon dilation in this patient and she experienced improvement. (Korean J Gastrointest Endosc 2010;41:240-244)

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Two Cases of Pyloric Stenosis Caused by Endoscopic Submucosal Dissection: Sang Hoon Park, M.D., Jin Woong Cho, M.D., Yong Keun Cho, M.D., Ji Woong Kim, M.D.,Gum Mo Jung, M.D. and Young Jae Lee, M.D.; Korean J Gastrointest Endosc 2010;40(4):261-265. Published online April 30, 2010

Abstract PDF: Endoscopic Submucosal Dissection (ESD) has recently become a widely accepted treatment for premalignent lesions of the stomach and early gastric cancer. Post-ESD stenosis is a rare complication of ESD, but this can be caused by the removal of a large lesion when lesions are located near the cardia or pylorus. We experienced two cases of post-ESD stenosis. One developed in a high risk patient and this was treated by repeated balloon dilation. The other occurred in a patient who was without risk factors, but the stenosis improved spontaneously. It is important that we should perform early follow-up endoscopy in patients who are at a high risk for post-ESD stenosis, and administer effective treatment. (Korean J Gastrointest Endosc 2010;40:261-265)

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The Safety and Effectiveness of Medium Endoscopic Sphincterotomy with Endoscopic Papillary Large Balloon Dilation for Removing Difficult Common Bile Duct Stones: Sun Hae Lee, M.D., Sung Wook Hong, M.D., Young Deok Cho, M.D., Young Koog Cheon, M.D., Sang Gyun Kim, M.D., Jae Young Jang, M.D., Young Seok Kim, M.D., Jong Ho Moon, M.D., Joon Seong Lee, M.D., Moon Sung Lee, M.D., Chan Sup Shim, M.D. and Boo Sung Kim, M.; Korean J Gastrointest Endosc 2007;35(2):80-86. Published online August 30, 2007

Abstract PDF: Background
/Aims: Mechanical lithotripsy is generally used when it is difficult to endoscopically remove common bile duct (CBD) stones. However, this procedure not only requires extensive experience, but it is also time consuming. Medium endoscopic sphincterotomy (medium EST) combined with endoscopic papillary large balloon dilation (EPLBD) is recently being increasingly used; therefore, the aim of this study was to evaluate the safety and effects of medium EST with EPLBD for patients with CBD stones that are difficult to remove. Methods: 41 patients with CBD stones that were difficult to remove by conventional endoscopic methods were enrolled in this study. EPLBD was performed after medium EST. The size of the stones, the procedure time, complications and the total number of sessions needed for stone removal were analyzed. Results: The mean size of the CBD stones was 18.2 ⁑ 7.7 mm, and the mean number of stones was 2.7. Additional mechanical lithotripsy for complete removal was required in 9.7% (4/41) of the patients. Procedure related complications occurred in 7% (3/41): bleeding in 1 case and acute pancreatitis in 2 cases. Conclusions: Medium EST with EPLBD was a safe and effective treatment modality for CBD stones that were difficult to remove. Further prospective randomized studies are needed for comparing the effectiveness and safety between conventional EST and medium EST with EPLBD for removing difficult CBD stones.

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Successful Removal of Common Bile Duct Stone Using Endoscopic Papillary Balloon Dilation (EPBD), in A 28-month-old Child with Down's Syndrome: Jee Heon Kang, M.D., Do Hyun Park, M.D., Jeung Hoon Park, M.D., Myung Ho Oh, M.D.*, Seung Hyo Han, M.D., Hyoung Su Ahn, M.D., Yong Ha Lee, M.D., Sang-Heum Park, M.D., Suck-Ho Lee, M.D., Il-Kwun Chung, M.D., Hong-Soo Kim, M.D. and Sun-Joo Kim, M.D.; Korean J Gastrointest Endosc 2006;33(2):125-129. Published online August 30, 2006

Abstract PDF: Although cholelithiasis is an uncommon condition in infants, a recent study documented the increasing detection of this disorder. This increase may be explained by the wide use and improvement in abdominal ultrasound. Choledocholithiasis with cholestatic jaundice in infants usually requires therapeutic intervention, even though the incidence of spontaneous resolution has been reported to be higher in infants than adults. Choledocholithiasis in children has traditionally been managed surgically with open common duct exploration. Recently, endoscopic stone removal was accepted as a standard therapy in pediatric choledocholithiasis. We report a case of the successful removal of common bile duct stone using endoscopic papillary balloon dilation (EPBD), in a 28-month-old infant with Down's syndrome. (Korean J Gastrointest Endosc 2006;33:125⁣129)

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십이지장 유두선종의 내시경적 유두절제술 후 발생한 총담관 결석을 동반한 담도 협착 1 예 ( Biliary Stricture Associated with Common Bile Duct Stone Caused by Endoscopic Snare Papillectomy of Ampullary Adenoma ): Korean J Gastrointest Endosc 2001;23(4):259-262. Published online November 30, 2000

Abstract PDF: Neoplasms of the major duodenal papilla or the ampulla of Vater are rare but are clinically important since they are premalignant. Recently endoscopic snare papillectomy for the ampullary adenoma is being increasingly performed. The procedure is now regarded as a clinically effective treatment, however, various complications such as bleeding, perforation, colangitis, and pancreatitis have been reported. To our knowledge, biliary stricture of this case has not been reported as a complication of endoscopic snare papillectomy for ampullary adenoma. Also, secondary common bile duct stone was formed by biliary stasis associated with biliary stricture in our case. We performed the balloon dilation at the biliary stricture site and could remove the stone successfully by endoscopic method. (Korean J Gastrointest Endosc 2001;23:259-262)

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