title: Efficacy and safety of low-pressured and short-time dilation in endoscopic papillary balloon dilation for bile duct stone removal.
abstract: 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.
authors: Departments of Gastroenterology, Japanese Red Cross Medical Center, Tokyo, Japan.
authors: Takeshi
authors: T
authors: Tsujino
authors: Takao
authors: T
authors: Kawabe
authors: Hiroyuki
authors: H
authors: Isayama
authors: Takashi
authors: T
authors: Sasaki
authors: Hirofumi
authors: H
authors: Kogure
authors: Osamu
authors: O
authors: Togawa
authors: Toshihiko
authors: T
authors: Arizumi
authors: Yukiko
authors: Y
authors: Ito
authors: Saburo
authors: S
authors: Matsubara
authors: Natsuyo
authors: N
authors: Yamamoto
authors: Yousuke
authors: Y
authors: Nakai
authors: Naoki
authors: N
authors: Sasahira
authors: Kenji
authors: K
authors: Hirano
authors: Nobuo
authors: N
authors: Toda
authors: Yutaka
authors: Y
authors: Komatsu
authors: Minoru
authors: M
authors: Tada
authors: Haruhiko
authors: H
authors: Yoshida
authors: Masao
authors: M
authors: Omata
mesh_terms: 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