Case of arterial hemorrhage after endoscopic papillary large balloon dilation for choledocholithiases using a covered self-expandable metallic stent

Figure 1 Choledocholithiases with a maximum diameter of 13 mm were identified on the cholangiogram.

Figure 2 Endoscopic image of the papilla of Vater was gradually worsening because of the adhesion of a significant amount of coagulation.

Figure 3 We placed a fully covered Wallflex^® self-expandable metallic stent that was 10 mm with an 8-cm diameter across the papilla of Vater, and hemorrhage stopped immediately.

Figure 4 Re-bleeding was not observed after the self-expandable metallic stent removal, and an ulcerative lesion appeared from the orifice of the papilla of Vater to the lower bile duct.

Figure 5 Direct peroral cholangioscopy revealed an exposed vessel with a laceration in the lower bile duct ulcerative area.