title: Is endoscopic balloon dilation for removal of bile duct stones associated with an increased risk for pancreatitis or a higher rate of hyperamylasemia?
abstract: OBJECTIVE
  We studied the rate of pancreatitis and asymptomatic hyperamylasemia after endoscopic balloon dilation (EBD) and endoscopic sphincterotomy (EST) for removal of bile duct stones.
  
  
  METHODS
  Patients with bile duct stones of all sizes were randomly allocated to undergo EBD (8-mm dilation balloon) or EST. Pancreatitis was defined as epigastric pain combined with at least a threefold rise in serum amylase at 24 hours after the endoscopic retrograde cholangiopancreatography (ERCP). Asymptomatic hyperamylasemia was defined as a threefold rise in serum amylase without epigastric pain.
  
  
  RESULTS
  There were 180 patients (67 men, 113 women; mean age 67, SD 16.2) available for analysis. Complete stone removal after a single ERCP was achieved in 82 (88%) of 93 EBD patients and in 81 (93%) of 87 EST patients (P = 0.38). Mechanical lithotripsy was used more frequently in the EBD group (31% vs. 13%, P = 0.005). Early complications occurred in 16 EBD patients (17%) and in 19 EST patients (22%) (P = 0.46). Pancreatitis was observed in seven patients in each group (8%). Logistic regression identified no significant predictors for the occurrence of pancreatitis. Asymptomatic hyperamylasemia occurred in 21 EBD patients (23%) vs seven EST patients (8%) (P = 0.008). Logistic regression identified EBD as the only significant predictor for asymptomatic hyperamylasemia: odds ratio 2.9 (95% confidence interval (CI) 1.1 to 7.3, R2 = 0.02).
  
  
  CONCLUSIONS
  We did not observe a difference in the rate of pancreatitis between EBD and EST. Asymptomatic hyperamylasemia was observed more frequently after EBD. Although asymptomatic hyperamylasemia is not a clinical entity, this finding may indicate that EBD causes more irritation of the pancreas than EST.
authors.affiliation: Dept. of Gastroenterology, Academic Medical Center, University of Amsterdam, The Netherlands. J.J.Bergman@AMC.UVA.NL
authors.forename: J J
authors.initials: JJ
authors.lastname: Bergman
authors.forename: A M
authors.initials: AM
authors.lastname: van Berkel
authors.forename: M J
authors.initials: MJ
authors.lastname: Bruno
authors.forename: P
authors.initials: P
authors.lastname: Fockens
authors.forename: E A
authors.initials: EA
authors.lastname: Rauws
authors.forename: J G
authors.initials: JG
authors.lastname: Tijssen
authors.forename: G N
authors.initials: GN
authors.lastname: Tytgat
authors.forename: K
authors.initials: K
authors.lastname: Huibregtse
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000681:Amylases / Q000097:blood*; D001649:Bile Duct Diseases / Q000097:blood / Q000628:therapy; D002404:Catheterization / Q000009:adverse effects*; D002769:Cholelithiasis / Q000097:blood / Q000628:therapy*; D016145:Endoscopy, Digestive System / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010195:Pancreatitis / Q000097:blood / Q000209:etiology*; D011183:Postoperative Complications; D012306:Risk; D016717:Sphincterotomy, Endoscopic / Q000009:adverse effects*
chemical_list: D000681:Amylases