Published online Apr 28, 2015. doi: 10.3748/wjg.v21.i16.5090
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
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.