Is balloon sweeping detrimental in portal biliopathy? A report of 3 cases.

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.