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Background: Endoscopic sphincterotomy (EST) is a standard procedure for the removal of bile duct stones. However, additional EST may increase the risk of bleeding and perforation in patients with prior EST. Endoscopic papillary large balloon dilation (EPLBD) can be an alternative method for removing recurrent common bile duct stones with lower risk of bleeding and perforation. The aim of this study was to evaluate the therapeutic outcomes and complications of EPLBD in patients with recurrent common duct stones who underwent EST previously. Methods: Between January 2006 and August 2009, 70 patients with recurrent bile duct stones who had a history of EST were studied retrospectively. All patients underwent EPLBD without additional EST to enlarge the ampullary orifice. The size of the balloon for EPLBD was 12-18 mm and the duration of the balloon dilatation was 30-60 s. Results: Of the 70 patients, there were 24 patients (34.3%) with periampullary diverticula, 18 patients (25.7%) with hypertension, 4 patients (5.7%) with ischemic heart diseases, 2 patients (2.9%) with liver cirrhosis, and 1 patient (1.4%) with chronic kidney disease. Mean diameter of the stones was 12.5 ± 5.5 mm. Complete clearance of the duct was achieved in all patients and mechanical lithotripsy was needed in 1 patient (1.4%). Sixty-eight cases (97.1%) required only 1 session of ERCP to achieve complete ductal clearance. Mild pancreatitis occurred in 1 patient (2.3%), but there was no bleeding or perforation. Conclusion: EPLBD is an effective and safe method for the treatment of recurrent common duct stones in patients with prior EST. [ABSTRACT FROM AUTHOR]

Nonsteroidal anti-inflammatory drugs (NSAIDs) occasionally induce small-bowel injury. However, the clinical features have only been partially clarified. The aim of this study was to clarify the clinical features of the disease and evaluate the effectiveness of endoscopic balloon dilation therapy for diaphragm disease, using double-balloon endoscopy (DBE). This is a retrospective case study using our DBE database. Our inclusion criteria required patients to meet all the following criteria: (1) history of NSAID use; (2) endoscopic findings of erosion and/or ulcer and/or typical diaphragm-like strictures; (3) improvement in clinical findings (signs and symptoms) and/or endoscopic findings by cessation of NSAIDs, except for diaphragm disease; and (4) exclusion of other causes (e.g., malignant tumor, inflammatory bowel disease, and infectious disease). The clinical records of patients were investigated. Eighteen patients were included. Sixteen patients showed ulcerative lesions, and the remaining 2 patients showed diaphragm diseases. For localized lesions, 12 patients evidenced lesions in the ileum, 5 patients had lesions in the duodenum and/or jejunum, and 1 had lesions in both intestines. The ulcerative lesions were multiple with various morphologies that were located unrelated to mesenteric or antimesenteric sides. The endoscopic balloon dilations were performed safely, and all patients improved with regard to their symptoms. Symptomatic NSAID-induced small-bowel injuries exhibit a variety of patterns of ulcerative lesions as observed in the ileum in many cases. The endoscopic balloon dilation appears to be a safe and effective treatment for diaphragm disease. [ABSTRACT FROM AUTHOR]