Hemostasis of uncontrolled bleeding using a temporary self-expandable metallic stent after endoscopic papillary large balloon dilation: A case report

An 82-year-old man with severe renal dysfunction was admitted because of epigastric pain. Hematological examination revealed elevated levels of hepatic and biliary tract enzymes, and computed tomography showed a hyper-dense lesion with an area of 18 x 13 mm in the common bile duct. The lesion was diagnosed as a common bile duct stone, and endoscopic retrograde cholangiopancreatography was performed to remove the stone. Following endoscopic sphincterotomy, papillary large balloon dilation was performed using a 10-12 mm balloon catheter. We expanded the balloon to 10 mm, at a pressure of 3 atmospheres, until the notch disappeared. However, bleeding occurred in spurts from the papilla and we were unable to determine the primary bleeding point. We immediately tried to obtain endoscopic hemostasis using a large balloon catheter to provide compression at the bleeding point. Despite maintaining pressure for >30 mm with the catheter, we could not control the bleeding. Because our patient was of advanced age with severe complications, we had to adopt a minimally invasive treatment. Therefore, we decided to attempt endoscopic hemostasis by placing a partially-covered self-expandable metallic stent in the distal bile duct [10mm diameter and 4cm length (Boston Scientific WallflexTM)1. The bleeding ceased, and we were able to avoid unnecessary surgery and interventional radiology. The stent was withdrawn 21 days later without complications.