title: Risk factors for pancreatitis in patients with common bile duct stones managed by endoscopic papillary balloon dilation.
abstract: 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.
authors.affiliation: Department of Gastroenterology, Japanese Red Cross Medical Center, 4-1-22 Hiroo, Shibuya-ku, Tokyo 150-8935, Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Tsujino
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Isayama
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Isayana
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Komatsu
authors.forename: Yukiko
authors.initials: Y
authors.lastname: Ito
authors.forename: Minoru
authors.initials: M
authors.lastname: Tada
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Minagawa
authors.forename: Ryo
authors.initials: R
authors.lastname: Nakata
authors.forename: Takao
authors.initials: T
authors.lastname: Kawabe
authors.forename: Masao
authors.initials: M
authors.lastname: Omata
mesh_terms: 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
chemical_list: D003287:Contrast Media