Stepwise Pressure Release Reduces Bleeding Complications after Endoscopic Papillary Balloon Dilation: A Retrospective Cohort Study

Objective The objective of this study was to investigate whether a stepwise pressure release technique reduces the risk of intraoperative and postoperative bleeding complications after Endoscopic Papillary Balloon Dilation (EPBD). Methods This retrospective cohort study included patients with common bile duct stones who underwent ERCP accompanied by EST and EPBD at Nanhua University Affiliated Nanhua Hospital. The observation group (stepwise pressure release, n = 757) consisted of patients treated between April 1, 2022 and October 31, 2025, and the control group (conventional one‑time release, n = 784) comprised those treated between January 1, 2020 and February 28, 2022. Following EPBD, balloon pressure in the observation group was released in four steps (25% per step at 60‑second intervals), whereas the control group underwent conventional immediate deflation. Outcome measures included intraoperative bleeding severity grade, postoperative reduction in hemoglobin level, incidence of hematemesis and melena, and other complications. Results The baseline characteristics were balanced between the two groups (P > 0.05). The distribution of intraoperative bleeding severity differed significantly (P < 0.001): the observation group had predominantly Grade 0 (52.18%) and Grade 1 (32.63%) bleeding, while the control group had mainly Grade 1 (43.49%) and Grade 2 (28.06%). The postoperative hemoglobin drop was lower in the observation group (10.57 ± 6.65 g/L) than in the control group (13.62 ± 7.86 g/L, P < 0.0001). The incidence of melena was also lower in the observation group (12.95%) compared to the control group (22.45%, P < 0.01). No significant differences were found between the groups in the incidence of non-bleeding complications such as post-ERCP pancreatitis and acute cholangitis (P > 0.05). Conclusion The stepwise pressure release technique after EPBD significantly reduces intraoperative bleeding severity, minimizes postoperative hemoglobin drop and melena occurrence, without increasing the risk of other complications. It represents a safe and effective technical modification.