title: Papillary balloon dilation is not itself a cause of post-endoscopic retrograde cholangiopancreatography pancreatitis; results of anterograde and retrograde papillary balloon dilation.
abstract: OBJECTIVE
  The mechanism of pancreatitis development following endoscopic papillary balloon dilation (EPBD) remains unknown. Antegrade dilation with percutaneous transhepatic papillary balloon dilation (PTPBD) allows the removal of bile duct stones or fragments during percutaneous choledochoscopic lithotomy, with less mechanical trauma to the papilla than with EPBD-mediated stone removal.
  
  
  METHODS
  A total of 56 patients with bile duct stones underwent antegrade dilation with PTPBD from March 2006 to February 2011. A total of 208 patients with common bile duct stones underwent retrograde dilation with EPBD during the same period. The conditions of papillary balloon dilation were identical in both groups. The frequencies of pancreatitis and hyperamylasemia were compared in both groups.
  
  
  RESULTS
  Pancreatitis occurred in 14 (6.7%) of 208 patients in the EPBD group (mild, nine; moderate, four; severe, one). There was no case of pancreatitis among 56 patients in the PTPBD group (P < 0.05). Hyperamylasemia developed in significantly more patients treated in the EPBD group (62, 29.8%) compared with the PTPBD group (4, 7.1%; P < 0.05). Complete bile duct clearance was achieved in 98.2% of PTPBD group and 97.1% of EPBD group.
  
  
  CONCLUSIONS
  The rates of post-procedural pancreatitis and hyperamylasemia were significantly higher after retrograde dilation with EPBD than after antegrade dilation with PTPBD for the removal of bile duct stones. Although the mechanism of pancreatitis following papillary balloon dilation remains unclear, post-EPBD pancreatitis may be associated with procedures before and after balloon dilation similar to mechanical lithotripsy rather than balloon dilation itself.
authors.affiliation: Digestive Disease Center and Research Institute, Department of Internal Medicine, Soon Chun Hyang University School of Medicine, Bucheon and Seoul, Korea.
authors.forename: Yu Ri
authors.initials: YR
authors.lastname: Seo
authors.forename: Jong Ho
authors.initials: JH
authors.lastname: Moon
authors.forename: Hyun Jong
authors.initials: HJ
authors.lastname: Choi
authors.forename: Dong Choon
authors.initials: DC
authors.lastname: Kim
authors.forename: Tae Hoon
authors.initials: TH
authors.lastname: Lee
authors.forename: Sang-Woo
authors.initials: SW
authors.lastname: Cha
authors.forename: Young Deok
authors.initials: YD
authors.lastname: Cho
authors.forename: Sang-Heum
authors.initials: SH
authors.lastname: Park
authors.forename: Sun-Joo
authors.initials: SJ
authors.lastname: Kim
mesh_terms: D000368:Aged; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects*; D042883:Choledocholithiasis / Q000628:therapy; D002769:Cholelithiasis / Q000628:therapy*; D004106:Dilatation / Q000009:adverse effects* / Q000379:methods*; D005260:Female; D006801:Humans; D034321:Hyperamylasemia / Q000453:epidemiology / Q000209:etiology; D008297:Male; D008875:Middle Aged; D010195:Pancreatitis / Q000453:epidemiology / Q000209:etiology*
keywords: endoscopic papillary balloon dilation; percutaneous transhepatic papillary balloon dilation; post-ERCP pancreatitis