4638 Endoscopic papillary balloon dilation in cirrhotic patients for the management of common bile duct stones

Aim: Endoscopic papillary balloon dilation (EPBD) is becoming popular as an effective procedure for the treatment of common bile duct stones in Japan.We previously reported the preliminary study on the efficacy of this procedure for cirrhotic patients as short communication (Endoscopy 1996; 28: 694-698).We reevaluate it in larger series in the present study. Patients and Methods: From November 1994 to October 1999, EPBD was performed to remove common bile duct stones in 36 consecutive cirrhotic patients. After balloon dilation of the papilla to a diameter of 4 to 8 mm, the stones were retrieved. The cirrhotic patients' background and characteristics were as following; their mean age was 64.9 years (28-89). The patients' Child-Pugh grades were A in 9 patients, B in 8, and C in 19. Thirteen of 36 patients showed severe coagulopathy (platelet counts of less than 50x103/ μl or a prolonged prothrombin time of more then two seconds). Nine of the 36 patients had hyperbilirubinemia of more than 3 mg/dl. Twenty one had hepatocellular carcinoma. Results: In conjunction with the usage of lithotripter in 6 patients with large stones, clearance of the common bile duct was achieved in all of the 36 patients. Mild pancreatitis occurred in 2 patients (5.5 %). In one patient, hemorrhage occurred during the stone removal although the papillary dilation itself did not cause hemorrhage. This patient was treated angiographically and required blood transfusion. There was no mortality. Conclusions: Endoscopic papillary balloon dilation is a safe and effective alternative for the treatment of common bile duct stones even in cirrhotic patients. EPBD may be preferred to sphincterotomy in patients with hemostatic disorders. However, careful attention should be paid to hemorrhage during removal of stones.