Shimizu S, Naitoh I, Nakazawa T, Hayashi K, Miyabe K, Kondo H, Nishi Y, Umemura S, Hori Y, Kato A, Ohara H, Joh T. Case of arterial hemorrhage after endoscopic papillary large balloon dilation for choledocholithiases using a covered self-expandable metallic stent. World J Gastroenterol 2015; 21(16): 5090-5095 [PMID: 25945025 DOI: 10.3748/wjg.v21.i16.5090]
Corresponding Author of This Article
Itaru Naitoh, MD, PhD, Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya 467-8601, Japan. inaito@med.nagoya-cu.ac.jp
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Shuya Shimizu, Itaru Naitoh, Takahiro Nakazawa, Kazuki Hayashi, Katsuyuki Miyabe, Hiromu Kondo, Yuji Nishi, Shuichiro Umemura, Yasuki Hori, Akihisa Kato, Takashi Joh, Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya 467-8601, Japan
Hirotaka Ohara, Department of Community-based Medical Education, Nagoya City University Graduate School of Medical Sciences, Nagoya 467-8601, Japan
Author contributions: Shimizu S designed the idea, collected clinical data and wrote the paper; Naitoh I designed the idea and wrote the paper; Nakazawa T designed the idea and wrote the paper; Hayashi K collected clinical data; Miyabe K collected clinical data; Kondo H collected clinical data; Nishi Y collected clinical data; Umemura S collected clinical data; Hori Y collected clinical data; Kato A collected clinical data; Ohara H collected clinical data; and Joh T designed the idea.
Ethics approval: The study was reviewed and approved by the Institutional Review Board of the Nagoya City University Graduate School of Medical Sciences (# 831).
Informed consent: The study was written informed consent was obtained from the patient prior to study enrollment.
Conflict-of-interest: The authors have no conflict of interest related to the manuscript.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Itaru Naitoh, MD, PhD, Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya 467-8601, Japan. inaito@med.nagoya-cu.ac.jp
Telephone: +81-52-8538211 Fax: +81-52-8520952
Received: October 5, 2014 Peer-review started: October 7, 2014 First decision: October 29, 2014 Revised: November 11, 2014 Accepted: January 8, 2015 Article in press: January 8, 2015 Published online: April 28, 2015 Processing time: 203 Days and 18.1 Hours
Abstract
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.
Core tip: We present a case study of arterial hemorrhage after endoscopic papillary large balloon dilation (EPLBD) that was treated using a covered self-expandable metallic stent (SEMS). After 1 wk of SEMS placement, a direct peroral cholangioscopy revealed a visible vessel with a longitudinal mucosal tear in the ulceration of the lower bile duct. This image is important for understanding the mechanism of hemorrhage after EPLBD.
