Do balloons larger than 15 mm in size increase the risk of adverse events in endoscopic large balloon dilation?
Endoscopic large balloon dilation (EPLBD) using large-diameter balloons (12-20 mm) was introduced to facilitate the removal of large bile duct stones and minimize the need for endoscopic mechanical lithotripsy (EML). Much recent literature has suggested EPLBD is safe and effective for extraction of large or difficult stones without any additional risk of lifethreatening pancreatitis or perforation. Nevertheless, limited data exist on the maximal balloon size that would minimize fatal adverse events associated with EPLBD. In the current study, we aimed to assess the safety profiles of EPLBD according to balloon size and to identify the proper maximal size of a large balloon for treating large bile duct stones. A total of 279 patients who underwent EPLBD were included in the present study. There were 114 patients in the EPLBD with endoscopic biliary sphincterotomy (EST) group and 165 patients in the EPLBD without EST group. In the EPLBD with EST group, there were 49 patients in the EPLBD with a larger balloon (>15 mm) group and 65 patients in the EPLBD with a smaller balloon (12-15 mm) group. Although no significant difference was found between the larger and smaller balloon groups in terms of adverse events, there was a trend toward the larger balloon group having a higher rate of severe to fatal adverse events. In the EPLBD without EST group, there were 36 patients in the EPLBD with a larger balloon (>15 mm) group and 129 patients in the EPLBD with a smaller balloon (12-15 mm) group. The safety variables did not differ significantly between the two groups, and no severe to fatal adverse event occurred in either group. In conclusion, our study shows that EPLBD with a larger balloon (>15 mm) tends to have more risk of severe to fatal adverse events compared with a smaller balloon (12-15 mm) for removing large bile duct stones. Large multicenter trials will be needed to reveal the statistical relationships between adverse events and balloon size.
Endoscopic large balloon dilation (EPLBD), Adverse events, Balloon size, 내시경적 유두부 큰 풍선 확장술, 부작용, 풍선 크기
Networked Digital Library of Theses and Dissertations