Efficacy of endoscopic nasobiliary drainage for the prevention of pancreatitis after papillary balloon dilatation: a pilot study.
OBJECTIVE
Endoscopic papillary balloon dilatation (EPBD) has been reported to increase the risk of post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (4%-11%). Based on the hypothesis that performing endoscopic nasobiliary drainage (ENBD) could prevent this complication, we performed EPBD combined with ENBD (EPBD/ENBD) and analyzed the risk of pancreatitis.


METHODS
Thirty-four patients underwent EPBD followed by ENBD for common bile duct stone(s). Serum amylase levels the following morning and incidence of pancreatitis were compared with those previously reported and with complications of simple diagnostic ERCP performed in our institution.


RESULTS
After EPBD/ENBD, amylase levels the following morning were 214.5 +/- 152.9 U/L, and no cases developed pancreatitis or hyperamylasemia (>3 times normal). These outcomes were favorable compared with previous EPBD reports. Furthermore, despite the stress of EPBD/ENBD after ERCP, these outcomes were better, even compared with simple ERCP performed at our institution [amylase levels: 318.7 +/- 475.2 U/L; hyperamylasemia: 16.5% (P = 0.006); pancreatitis: 7.1%].


CONCLUSIONS
Although EPBD has been regarded as a risk factor for post-ERCP pancreatitis, our results suggest the possibility that application of ENBD after EPBD decreases the incidence of pancreatitis and should be studied further. We speculate that ENBD itself prevents pancreatic duct obstruction by residual stones or papillary edema.
Sato
Daisuke
D
Department of Gastroenterology, Institute of Clinical Medicine, University of Tsukuba, Tsukuba, Japan.
Shibahara
Takeshi
T
Miyazaki
Kaori
K
Matsui
Hirohumi
H
Yanaka
Akinori
A
Nakahara
Akira
A
Tanaka
Naomi
N
D000328:Adult; D000368:Aged; D002404:Catheterization / Q000009:adverse effects*; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects*; D004322:Drainage / Q000379:methods*; D016145:Endoscopy, Digestive System / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009296:Nasal Cavity / Q000601:surgery; D010195:Pancreatitis / Q000209:etiology / Q000517:prevention & control*; D010865:Pilot Projects; D015607:Stents