title: Endoscopic papillary large balloon dilation for treatment of large bile duct stones does not increase the risk of post-procedure pancreatitis.
abstract: OBJECTIVE
  Endoscopic sphincterotomy (ES) and endoscopic papillary large balloon dilation (EPLBD) are well-known procedures for the treatment of common duct stones. There was no statistically significant difference in post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis rates between ES and EPLBD in most studies. The aims of this study were to evaluate whether EPLBD increases the risk of post-ERCP pancreatitis and to identify the risk factors influencing post-ERCP pancreatitis.
  
  
  METHODS
  A review of 341 patients who underwent ERCP for treatment of common duct stones larger than 1 cm in diameter from January 2006 to December 2011 was conducted retrospectively. Patients were divided into three groups: ES group (n = 207), EPLBD + ES group (n = 99), and EPLBD with previous history of ES group (n = 35).
  
  
  RESULTS
  Of 341 patients, overall incidence of post-ERCP pancreatitis was 2.6% (n = 9). Incidence of post-ERCP pancreatitis was 3.4, 2.0, and 0% in the ES group, EPLBD + ES group, and EPLBD with previous history of ES group, respectively. No significant difference in the incidence of post-ERCP pancreatitis was observed among the three groups (p = 0.47). Endoscopic biliary stenting was the independent risk factor for pancreatitis according to univariate (p = 0.046) and multivariate analyses (p = 0.036, OR 4.211, 95% CI 1.095-16.199). Age, sex, stone size, mechanical lithotripsy, common bile duct diameter, balloon size, and duration of balloon dilation were not significantly related to post-ERCP pancreatitis.
  
  
  CONCLUSIONS
  EPLBD with antecedent limited ES or previous ES state does not increase the risk of post-ERCP pancreatitis in patients with large bile duct stones. Endoscopic biliary stenting seems to be the independent risk factor of post-ERCP pancreatitis.
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Internal Medicine, Yeungnam University College of Medicine, 317-1 Daemyung 5-dong, Nam-gu, Daegu, Korea.
authors.forename: Jun Suk
authors.initials: JS
authors.lastname: Park
authors.forename: Tae Nyeun
authors.initials: TN
authors.lastname: Kim
authors.forename: Kook Hyun
authors.initials: KH
authors.lastname: Kim
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects / Q000379:methods; D005260:Female; D042882:Gallstones / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010195:Pancreatitis / Q000209:etiology*; D011183:Postoperative Complications / Q000473:pathology*; D012189:Retrospective Studies; D016717:Sphincterotomy, Endoscopic / Q000009:adverse effects* / Q000379:methods; D055815:Young Adult