Endoscopy 2020; 52(06): E213-E214
DOI: 10.1055/a-1071-7649
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Endoscopic papillary large balloon dilation for pancreatic duct stone: a first report

Kosuke Iwano
Department of Gastroenterology and Hepatology, Kitano Hospital, Tazuke Kofukai Medical Research Institute.
,
Akira Kurita
Department of Gastroenterology and Hepatology, Kitano Hospital, Tazuke Kofukai Medical Research Institute.
,
Yoshiharu Mori
Department of Gastroenterology and Hepatology, Kitano Hospital, Tazuke Kofukai Medical Research Institute.
,
Shunjiro Azuma
Department of Gastroenterology and Hepatology, Kitano Hospital, Tazuke Kofukai Medical Research Institute.
,
Shujiro Yazumi
Department of Gastroenterology and Hepatology, Kitano Hospital, Tazuke Kofukai Medical Research Institute.
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Weitere Informationen

Corresponding author

Akira Kurita, MD, PhD
Department of Gastroenterology and Hepatology
Kitano Hospital, Tazuke Kofukai Medical Research Institute
2-4-20, Ohgimachi
Kita-ku, Osaka 530-8480
Japan   
Fax: +81-6-63610588   

Publikationsverlauf

Publikationsdatum:
20. Dezember 2019 (online)

 

    A 44-year-old woman, who had been a heavy drinker, was admitted to our hospital for treatment of a pancreatic duct stone with chronic pancreatitis. She had a previous history of endoscopic sphincterotomy for bile duct stones.

    Her laboratory examination showed no abnormalities. Contrast-enhanced computed tomography and magnetic resonance cholangiopancreatography revealed a large pancreatic duct stone with a diameter of 10 mm within the main pancreatic duct (MPD) in the pancreatic head, causing proximal dilation of the MPD ([Fig. 1]). During endoscopic retrograde cholangiopancreatography, endoscopic papillary large balloon dilation (EPLBD) with a balloon catheter (Giga II EPLBD Balloon catheter; Century Medical, Tokyo, Japan) was performed, and a large pancreatic duct stone was successfully removed without any adverse events ([Fig. 2], [Fig. 3], [Video 1]).

    Zoom
    Fig. 1 Initial imaging studies showed a large pancreatic duct stone (arrowhead) within the main pancreatic duct (MPD) in the pancreatic head, causing proximal dilation of the MPD. a Contrast-enhanced computed tomography. b Magnetic resonance cholangiopancreatography.
    Zoom
    Fig. 2 Endoscopic views. a The ampullary orifice during endoscopic papillary large balloon dilation of the pancreatic duct. b The large pancreatic duct stone was successfully removed using a basket catheter.
    Zoom
    Fig. 3 Fluoroscopic view during endoscopic papillary large balloon dilation.

    Video 1 During endoscopic retrograde cholangiopancreatography, endoscopic papillary large balloon dilation with a balloon catheter was performed and a large pancreatic duct stone was successfully removed.

    Pancreatic duct stones are a common complication of chronic pancreatitis. Although extracorporeal shock wave lithotripsy (ESWL) is the most common method of treating pancreatic duct stones, large stones remain a therapeutic challenge. This is the first reported case in which EPLBD was performed in the pancreatic duct and a large pancreatic duct stone was successfully removed without using ESWL. Although further clinical studies with larger samples and long-term follow-up are needed to validate and assess its safety, EPLBD should be one of the standard methods of treating pancreatic duct stones.

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    Competing interests

    The authors declare that they have no conflict of interest.


    Corresponding author

    Akira Kurita, MD, PhD
    Department of Gastroenterology and Hepatology
    Kitano Hospital, Tazuke Kofukai Medical Research Institute
    2-4-20, Ohgimachi
    Kita-ku, Osaka 530-8480
    Japan   
    Fax: +81-6-63610588   


    Zoom
    Fig. 1 Initial imaging studies showed a large pancreatic duct stone (arrowhead) within the main pancreatic duct (MPD) in the pancreatic head, causing proximal dilation of the MPD. a Contrast-enhanced computed tomography. b Magnetic resonance cholangiopancreatography.
    Zoom
    Fig. 2 Endoscopic views. a The ampullary orifice during endoscopic papillary large balloon dilation of the pancreatic duct. b The large pancreatic duct stone was successfully removed using a basket catheter.
    Zoom
    Fig. 3 Fluoroscopic view during endoscopic papillary large balloon dilation.