Endoscopic papillary balloon dilation can be safely performed in patients with dual antiplatelet therapy: A pilot study

Abstract

Abstract Endoscopic papillary balloon dilation (EPBD)—a low-risk procedure for bleeding—has been suggested as an alternative to endoscopic sphincterotomy (EST) for papillary dilatation in patients undergoing choledocholithotomy and at a high risk of bleeding. Several guidelines recommend dual antiplatelet therapy (DAPT) be reduced to single antiplatelet therapy (SAPT) when EST is performed. However, there is no evidence that EPBD increases the risk of bleeding in patients receiving DAPT. Thus, we aimed to address this problem. We included 31 patients who underwent EPBD for CBD stones and received DAPT or SAPT prior to EPBD (9 in the DAPT group and 22 in the SAPT group) treated at our hospital from May 2014 to August 2022. The DAPT group included patients who underwent EPBD without antiplatelet therapy withdrawal or with a shorter withdrawal period than those recommended by the guidelines. In the DAPT group, one of the two antiplatelet agents used was thienopyridine. No bleeding was observed after EPBD in this study. We did not find any significant between-group differences in the change in hemoglobin levels and post-ERCP pancreatitis. Thus, we propose that EPBD does not increase the bleedingrisk in patients with DAPT.