Open AccessCase of arterial hemorrhage after endoscopic papillary large balloon dilation for choledocholithiases using a covered self-expandable metallic stent
Author(s) -
Shuya Shimizu,
Itaru Naitoh,
Takahiro Nakazawa,
Kazuki Hayashi,
Katsuyuki Miyabe,
Hiromu Kondo,
Yuji Nishi,
Shuichiro Umemura,
Yasuki Hori,
Akihisa Kato,
Hirotaka Ohara,
Takashi Joh
Publication year - 2015
Publication title -
world journal of gastroenterology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.427
H-Index - 155
eISSN - 2219-2840
pISSN - 1007-9327
DOI - 10.3748/wjg.v21.i16.5090
Subject(s) - major duodenal papilla , medicine , balloon dilation , balloon , bile duct , self expandable metallic stent , hemostasis , surgery , balloon catheter , endoscopy , endoscope , stent , common bile duct , radiology
A 78-year-old male was admitted to our hospital because of choledocholithiasis. ERC demonstrated choledocholithiases with a maximum diameter of 13 mm, and we performed endoscopic papillary large balloon dilation (EPLBD) with a size of 15 mm. Immediately following the balloon deflation, spurting hemorrhage occurred from the orifice of the duodenal papilla. Although we performed endoscopic hemostasis by compressing the bleeding point with the large balloon catheter, we could not achieve hemostasis. Therefore, we placed a 10 mm fully covered self-expandable metallic stent (SEMS) across the duodenal papilla, and the hemorrhage stopped immediately. After 1 wk of SEMS placement, duodenal endoscopy revealed ulcerative lesions in both the orifice of the duodenal papilla and the lower bile duct. A direct peroral cholangioscopy using an ultra-slim upper endoscope revealed a visible vessel with a longitudinal mucosal tear in the ulceration of the lower bile duct. We believe that the mucosal tear and subsequent ruptured vessel were caused by the EPLBD procedure.