Endoscopic Papillary Balloon Dilation Can Be Safely Performed in Patients on Dual Antiplatelet Therapy: A Pilot Study

Abstract

Background and Aims: Endoscopic papillary balloon dilation (EPBD), a low-risk procedure for bleeding, hasbeen suggested as an alternative to endoscopic sphincterotomy for papillary dilatation in patients undergoingendoscopic stone removal who are at a higher risk of bleeding. Several guidelines recommend that combinationof two antiplatelet agents should be reduced to single antiplatelet therapy when endoscopic sphincterotomyis performed. However, there is no evidence that EPBD affects the risk of bleeding in patients receiving acombination of two antiplatelet agents; thus, we aimed to explore this problem. Methods: We included 31 patients who underwent EPBD for common bile duct stones at our hospital fromMay 2014 to August 2022 and received either a combination of two antiplatelet agents or single antiplatelettherapy prior to the procedure. The group receiving a combination of two antiplatelet agents included patientswho underwent EPBT without antiplatelet therapy withdrawal or with a shorter withdrawal period than thoserecommended by the guidelines. Results: In the group that received a combination of two antiplatelet agents, one of the two antiplateletagents used was thienopyridine. No bleeding was observed after EPBD in this study. We did not findany significant between-group differences in hemoglobin levels and rate of post-endoscopic retrogradecholangiopancreatography pancreatitis. Conclusions: In patients treated with a combination of two antiplatelet agents, EPBD could be safely performedwithout bleeding. Therefore, future prospective studies are warranted.