BACKGROUND: Portal biliopathy is characterized by biliary obstruction and is commonly caused by dilated vascular channels in the pericholedochal plexus causing choledochal varices, leading to the formation of stones in the common bile duct. Endoscopic treatment leads to severe bleeding complications because of the rupture of these vascular channels. OBJECTIVE: We report on our management of the unique bleeding complications we faced when performing endotherapy on these patients. DESIGN: A case series. SETTING: Single-center experience in a tertiary care unit. PATIENTS AND INTERVENTIONS: Patients with portal hypertension and choledochal varices, presenting with symptoms of biliary obstruction caused by gallstones, were subjected to ERCP and stone removal by use of the balloon sweeping and basket extraction techniques. LIMITATION: Small volume case series; there is need for a randomized controlled study. CONCLUSION: During stone removal, when compared to basket extraction, excessive bleeding was observed when balloon sweeping was used because this technique could cause squeezing of the choledochal varices.
BACKGROUND: Portal biliopathy is characterized by biliary obstruction and is commonly caused by dilated vascular channels in the pericholedochal plexus causing choledochal varices, leading to the formation of stones in the common bile duct. Endoscopic treatment leads to severe bleeding complications because of the rupture of these vascular channels. OBJECTIVE: We report on our management of the unique bleeding complications we faced when performing endotherapy on these patients. DESIGN: A case series. SETTING: Single-center experience in a tertiary care unit. PATIENTS AND INTERVENTIONS:Patients with portal hypertension and choledochal varices, presenting with symptoms of biliary obstruction caused by gallstones, were subjected to ERCP and stone removal by use of the balloon sweeping and basket extraction techniques. LIMITATION: Small volume case series; there is need for a randomized controlled study. CONCLUSION: During stone removal, when compared to basket extraction, excessive bleeding was observed when balloon sweeping was used because this technique could cause squeezing of the choledochal varices.
Authors: Irene Franceschet; Alberto Zanetto; Alberto Ferrarese; Patrizia Burra; Marco Senzolo Journal: World J Gastroenterol Date: 2016-12-07 Impact factor: 5.742