Efficacy and safety of low-pressured and short-time dilation in endoscopic papillary balloon dilation for bile duct stone removal.
OBJECTIVE
Endoscopic papillary balloon dilation (EPBD) has been advocated as an alternative therapy to endoscopic sphincterotomy for bile duct stones. However, studies have shown that EPBD may increase the risk for pancreatitis. Pancreatitis after EPBD is believed to be related to papillary damage after balloon dilation. We changed the dilation method to a theoretically less hazardous one. This modified dilation method was compared with the initial method.


METHODS
A total of 324 patients with bile duct stones underwent EPBD by the modified method between June 1999 and June 2003. Three hundred and twenty-four patients undergoing EPBD by the initial method served as a historical control group. The success rate of stone removal and the incidence of procedure-related pancreatitis were compared between the two groups. In the modified method, the balloon was inflated until disappearance of the balloon waist, and the pressure was then maintained for 15 s. In the initial method, the balloon was inflated at 8 atmospheres for 2 min.


RESULTS
Bile duct stones were successfully removed in 313 of 324 patients (96.6%) in the modified group and in 314 of 324 patients (96.9%) in the initial group (not significant). The incidence of post-procedure pancreatitis showed a lower tendency in the modified group (4.0%, 13/324) than in the initial group (7.4%, 24/324) (P-value = 0.0626). The severity of pancreatitis was significantly reduced in the modified group.


CONCLUSIONS
The modified method of EPBD is feasible for extraction of bile duct stones, and may potentially decrease the incidence of severe post-EPBD pancreatitis.
Tsujino
Takeshi
T
Departments of Gastroenterology, Japanese Red Cross Medical Center, Tokyo, Japan.
Kawabe
Takao
T
Isayama
Hiroyuki
H
Sasaki
Takashi
T
Kogure
Hirofumi
H
Togawa
Osamu
O
Arizumi
Toshihiko
T
Ito
Yukiko
Y
Matsubara
Saburo
S
Yamamoto
Natsuyo
N
Nakai
Yousuke
Y
Sasahira
Naoki
N
Hirano
Kenji
K
Toda
Nobuo
N
Komatsu
Yutaka
Y
Tada
Minoru
M
Yoshida
Haruhiko
H
Omata
Masao
M
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014670:Ampulla of Vater; D016022:Case-Control Studies; D002404:Catheterization / Q000009:adverse effects / Q000379:methods*; D002760:Cholangiopancreatography, Endoscopic Retrograde; D042883:Choledocholithiasis / Q000628:therapy*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010195:Pancreatitis / Q000209:etiology / Q000517:prevention & control; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome