Epinephrine irrigation for the prevention of pancreatic damage after endoscopic balloon sphincteroplasty.
OBJECTIVE
Endoscopic balloon sphincteroplasty (EBS) is an alternative to sphincterotomy for the treatment of bile duct stones. The purpose of this study was to determine if epinephrine irrigation of the papilla can prevent the pancreatic damage associated with EBS.


METHODS
A total of 173 patients with bile duct stones were treated by EBS. After conventional endoscopic retrograde cholangiography, EBS was performed by using a biliary dilatation catheter (balloon diameter: 8 mm). The duct was then cleared by using Dormia baskets or retrieval balloon catheters. Mechanical lithotripsy was performed before extraction when the stones were greater than 8 mm in diameter. In 81 patients, the dilated orifice was irrigated with 40-120 mL (50 +/- 37 mL) of 1:1,000,000 epinephrine (epinephrine group). In the remaining 92 patients, epinephrine irrigation was not performed (control group). Acute pancreatitis was defined by a serum amylase concentration fivefold greater than the upper limits of normal in association with abdominal pain.


RESULTS
After EBS, serum amylase concentrations were significantly increased in both groups. However, the degree of hyperamylasemia was less in the epinephrine group than in the control group (617 +/- 611 vs 1037 +/- 1491 IU/L, P < 0.05). The incidence of pancreatitis was lower in the epinephrine group than in the control group (1.2 vs 7.6%, P < 0.05).


CONCLUSIONS
Epinephrine irrigation is a simple and useful method to prevent post-EBS pancreatic damage and pancreatitis.
Ohashi
A
A
Department of Gastroenterology, Jichi Medical School, Yakushiji, Tochigi, Japan. ohashi@jichi.ac.jp
Tamada
K
K
Tomiyama
T
T
Wada
S
S
Higashizawa
T
T
Gotoh
Y
Y
Satoh
Y
Y
Miyata
T
T
Tano
S
S
Ido
K
K
Sugano
K
K
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000681:Amylases / Q000097:blood; D001649:Bile Duct Diseases / Q000000981:diagnostic imaging / Q000628:therapy; D002404:Catheterization / Q000009:adverse effects / Q000379:methods*; D002760:Cholangiopancreatography, Endoscopic Retrograde; D002769:Cholelithiasis / Q000000981:diagnostic imaging / Q000628:therapy*; D004837:Epinephrine / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010195:Pancreatitis / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D009803:Sphincter of Oddi; D007507:Therapeutic Irrigation
D000681:Amylases; D004837:Epinephrine