case_images: PMC11308825_01
case_images: Abdominal computed tomography at the time of hospitalization. Abdominal computed tomography showing common bile duct dilation and common bile duct stone in axial (A) and coronal (B) views.
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case_images: Abdominal computed tomography (CT) revealed common bile duct dilation and common bile duct stones (Figure 1).
case_images: Endoscopic retrograde cholangiopancreatography images. (A) Endoscopic retrograde cholangiopancreatography showing a common bile duct stone, indicated by the yellow arrow. (B) Endoscopic papillary balloon dilation being performed with a biliary balloon dilation catheter. (C) The common bile duct stone is extracted with a basket.
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case_images: After cannulation of the common bile duct with a 5-Fr catheter (ERCP catheter; MTW Endoskopie, Wesel, Germany) and a guidewire (J-WIRE Prologue; J-MIT, Kyoto, Japan), ERCP revealed a stone, approximately 10 mm in size, in the common bile duct (Figure 2A). Due to the lack of a sufficient prasugrel withdrawal period, EPBD was performed instead of EST with a biliary balloon dilation catheter for 2 minutes after confirming the disappearance of the notch (REN 10-12 mm, Kaneka Medical Products, Tokyo, Japan) (Figure 2B). Subsequently, we successfully extracted the common bile duct stone using a basket (FlowerBasket V; Olympus Medical Systems, Tokyo, Japan) (Figure 2C).
case_images: Abdominal contrast-enhanced computed tomography after hematemesis the day after the procedure. Abdominal contrast-enhanced computed tomography showing contrast leakage (yellow arrowheads) into the descending duodenal limb in axial (A) and coronal (B) views.
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case_images: EPBD was suspected (Figure 3). Emergency upper gastrointestinal endoscopy with a side-viewing duodenoscope (TGF-290V; Olympus Medical Systems, Tokyo, Japan) revealed spurting bleeding from the papillary region (Figure 4A).
case_images: Emergency upper gastrointestinal endoscopy images. Contrast leakage into the descending duodenal limb. (A) Emergency upper gastrointestinal endoscopy showing spurting bleeding from the papillary region. (B) Clip hemostasis was performed on a visible bleeding vessel to prevent blockage of the pancreatic duct.
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case_images: PMC11308825_01_gr4.jpg
case_images: fig4
case_images: EPBD was suspected (Figure 3). Emergency upper gastrointestinal endoscopy with a side-viewing duodenoscope (TGF-290V; Olympus Medical Systems, Tokyo, Japan) revealed spurting bleeding from the papillary region (Figure 4A). Clip hemostasis was performed on the visible bleeding vessel to prevent blockage of the pancreatic duct opening (Figure 4B).