Predictive factors for acute pancreatitis and hyperamylasemia after endoscopic papillary balloon dilation.
BACKGROUND
Although endoscopic papillary balloon dilation may result in acute pancreatitis or hyperamylasemia, the risk factors for these complications have not been well documented. Risk factors predictive of acute pancreatitis and hyperamylasemia after endoscopic papillary balloon dilation were retrospectively analyzed.


METHODS
In 118 patients who underwent endoscopic papillary balloon dilation for choledocholithiasis, postendoscopic papillary balloon dilation acute pancreatitis and hyperamylasemia (at least 3-fold elevation) were investigated. A multivariate analysis was conducted for 20 potential risk factors related to clinical and procedure characteristics.


RESULTS
Bile duct clearance was achieved in 113 patients. Early complications in the form of mild pancreatitis occurred in 7 patients (6%). Multivariate analysis identified history of acute pancreatitis as the only risk factor for postendoscopic papillary balloon dilation pancreatitis. Postendoscopic papillary balloon dilation hyperamylasemia occurred in 30 patients (25%). Multivariate analysis identified 4 independent risk factors for hyperamylasemia: an age of 60 years or less, previous pancreatitis, bile duct diameter 9 mm or less, and difficult bile duct cannulation.


CONCLUSIONS
Endoscopic papillary balloon dilation is associated with a relatively low occurrence (6%) of pancreatitis but a high frequency (25%) of hyperamylasemia. The latter may represent pancreatic irritation or latent pancreatic injury. Particular care is necessary when endoscopic papillary balloon dilation is performed in younger patients, those with a history of pancreatitis, patients with a nondilated bile duct, and when cannulation is difficult.
Sugiyama
Masanori
M
The First Department of Surgery, Kyorin University School of Medicine, Tokyo, Japan.
Izumisato
Yumi
Y
Abe
Nobutsugu
N
Masaki
Tadahiko
T
Mori
Toshiyuki
T
Atomi
Yutaka
Y
D000208:Acute Disease; D000368:Aged; D002404:Catheterization / Q000009:adverse effects*; D016145:Endoscopy, Digestive System; D005260:Female; D006801:Humans; D034321:Hyperamylasemia / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010195:Pancreatitis / Q000209:etiology*; D012307:Risk Factors