title: Effects of endoscopic papillary balloon dilation and endoscopic sphincterotomy on bacterial contamination of the biliary tract.
abstract: OBJECTIVE
  Although endoscopic papillary balloon dilation (EPBD) has appeared with the expectation of better preserving sphincter of Oddi function than endoscopic sphincterotomy (EST), whether it can more effectively prevent bacterial contamination of the biliary tract than EST is controversial. To address this issue, we investigated the bacterial flora in the bile after the two procedures.
  
  
  METHODS
  Eighty-six patients were alternately allocated to EPBD or EST. Blood-liver function tests, ultrasonography, and endoscopic retrograde cholangiopancreatography were performed 6 months and 2 years after EPBD or EST, and the bile was sampled for bacterial culture during endoscopic retrograde cholangiopancreatography. Bactobilia and late complications were prospectively compared between the two procedures.
  
  
  RESULTS
  Overall, no significant difference was found in the incidence of bactobilia between EPBD and EST at the two examination points. Limiting stone diameter to 8 mm or less, there was a trend toward lower rate of bactobilia in the EPBD group 2 years later although the statistical significance disappeared after correction for multiple comparisons. The absence rate of late complications after EPBD was higher than that after EST, but there was no significant difference between the two procedures, both for the overall patients and for the patients with small stones.
  
  
  CONCLUSIONS
  EPBD has a possibility of suppressing bacterial contamination of the biliary tract compared with EST in patients with small stones. A large, long-term follow-up, randomized, controlled trial is necessary to clarify whether this benefit of EPBD reduces late complications.
authors: Department of Internal Medicine, Niigata Prefectural Shibata Hospital, Shibata, Niigata, Japan. natsui@sirius.ocn.ne.jp
authors: Masaaki
authors: M
authors: Natsui
authors: Terasu
authors: T
authors: Honma
authors: Takuya
authors: T
authors: Genda
authors: Hiroto
authors: H
authors: Nakadaira
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001419:Bacteria / Q000302:isolation & purification*; D001646:Bile / Q000382:microbiology*; D001649:Bile Duct Diseases / Q000473:pathology / Q000628:therapy; D002404:Catheterization / Q000009:adverse effects* / Q000379:methods; D002760:Cholangiopancreatography, Endoscopic Retrograde; D002764:Cholecystitis / Q000209:etiology; D002769:Cholelithiasis / Q000473:pathology / Q000628:therapy; D016145:Endoscopy, Digestive System / Q000009:adverse effects / Q000379:methods; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016717:Sphincterotomy, Endoscopic / Q000009:adverse effects* / Q000379:methods; D016896:Treatment Outcome