Risk factors for pancreatitis in patients with common bile duct stones managed by endoscopic papillary balloon dilation.
OBJECTIVE
Endoscopic papillary balloon dilation has been accepted as a possible alternative to endoscopic sphincterotomy, especially in patients with impaired hemostasis. However, pancreatitis associated with endoscopic papillary balloon dilation has remained a controversial, serious issue. The aim of the study was to investigate the risk factors for postendoscopic papillary balloon dilation pancreatitis in a single-center study.


METHODS
A total of 304 patients who underwent endoscopic papillary balloon dilation for the management of common bile duct stones were enrolled. The risk of postendoscopic papillary balloon dilation pancreatitis was evaluated and the risk factors were analyzed by univariate and multivariate analysis. Definition and grade of the severity of postendoscopic papillary balloon dilation pancreatitis were based on the 1991 consensus guidelines.


RESULTS
Common bile duct was cleared in 292 of 304 patients (96%). Procedure-related pancreatitis occurred in 15 patients (5.0%). The grade was mild in 8 and moderate in 7. Two risk factors, stone diameter and contrast medium injection to the pancreas, were identified by univariate analysis. Finally, only the contrast medium injection to the pancreas was statistically significant by multivariate analysis. Prior history of pancreatitis was identified as a risk factor for postendoscopic papillary balloon dilation pancreatitis in previous studies, but this factor was not identified as a risk factor in our series.


CONCLUSIONS
Although the pathogenesis of pancreatitis after endoscopic papillary balloon dilation remains unresolved, the unnecessary injection of contrast medium to the pancreas can certainly be considered to be associated with the increased risk of pancreatitis.
Tsujino
Takeshi
T
Department of Gastroenterology, Japanese Red Cross Medical Center, 4-1-22 Hiroo, Shibuya-ku, Tokyo 150-8935, Japan.
Isayama
Hiroyuki
H
Isayana
Hiroyuki
H
Komatsu
Yutaka
Y
Ito
Yukiko
Y
Tada
Minoru
M
Minagawa
Nobuyuki
N
Nakata
Ryo
R
Kawabe
Takao
T
Omata
Masao
M
D000368:Aged; D002404:Catheterization / Q000009:adverse effects*; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects*; D015331:Cohort Studies; D003287:Contrast Media / Q000009:adverse effects; D005260:Female; D042882:Gallstones / Q000473:pathology / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010179:Pancreas / Q000187:drug effects / Q000473:pathology; D010195:Pancreatitis / Q000209:etiology* / Q000473:pathology; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome
D003287:Contrast Media