摘要
Background To determine whether endoscopic papillary balloon dilation decrease s the risk of hemorrhage without increasing the risk of acute pancreatitis, the results of endoscopic papillary balloon dilation were compared with those of end oscopic biliary sphincterotomy in patients with cirrhosis and coagulopathy. Meth ods Twenty-one patients with liver cirrhosis with coagulopathy had endoscopic p apillary balloon dilation for choledocholithiasis from January 2001 to September 2003.Twenty patients with cirrhosis and coagulopathy who underwent endoscopic b iliary sphincterotomy from January 1998 to December 2000, served as a historical control group. Results The rate of endoscopic biliary sphincterotomy related he morrhage was 30%(6/20),whereas the rate for endoscopic papillary balloon dilati on related hemorrhage was 0%(p=0.009). With regard to rates of hemorrhage in re lation to Child-Pugh class,most (n=5) of the bleeding complications occurred in patients with Child-Pugh class C cirrhosis; bleeding occurred in only one pati ent with Child-Pugh B cirrhosis. There was no significant difference between th e endoscopic biliary sphincterotomy and the endoscopic papillary balloon dilatio n groups for procedure-related pancreatitis (10%vs. 4.7%, respectively; p >0. 05).Conclusions Endoscopic papillary balloon dilation may significantly reduce the risk of bleeding compa red with endoscopic biliary sphincterotomy in patients with advanced cirrhosis a nd coagulopathy. In these patients, the substitution of endoscopic papillary bal loon dilation for endoscopic biliary sphincterotomy is recommended for treatment of choledocholithiasis.
Background To determine whether endoscopic papillary balloon dilation decrease s the risk of hemorrhage without increasing the risk of acute pancreatitis, the results of endoscopic papillary balloon dilation were compared with those of end oscopic biliary sphincterotomy in patients with cirrhosis and coagulopathy. Meth ods Twenty-one patients with liver cirrhosis with coagulopathy had endoscopic p apillary balloon dilation for choledocholithiasis from January 2001 to September 2003.Twenty patients with cirrhosis and coagulopathy who underwent endoscopic b iliary sphincterotomy from January 1998 to December 2000, served as a historical control group. Results The rate of endoscopic biliary sphincterotomy related he morrhage was 30%(6/20),whereas the rate for endoscopic papillary balloon dilati on related hemorrhage was 0%(p=0.009). With regard to rates of hemorrhage in re lation to Child-Pugh class,most (n=5) of the bleeding complications occurred in patients with Child-Pugh class C cirrhosis; bleeding occurred in only one pati ent with Child-Pugh B cirrhosis. There was no significant difference between th e endoscopic biliary sphincterotomy and the endoscopic papillary balloon dilatio n groups for procedure-related pancreatitis (10%vs. 4.7%, respectively; p >0. 05).Conclusions Endoscopic papillary balloon dilation may significantly reduce the risk of bleeding compa red with endoscopic biliary sphincterotomy in patients with advanced cirrhosis a nd coagulopathy. In these patients, the substitution of endoscopic papillary bal loon dilation for endoscopic biliary sphincterotomy is recommended for treatment of choledocholithiasis.