title: Balloon dilation itself may not be a major determinant of post-endoscopic retrograde cholangiopancreatography pancreatitis.
abstract: Endoscopic retrograde cholangiopancreatography (ERCP) is the essential first modality for common bile duct (CBD) stone therapy. The conventional endoscopic treatment for CBD stones is stone removal after endoscopic sphincterotomy (EST). Stone removal after papillary stretching using balloon dilation instead of the conventional method has been widely adopted. There are many reports regarding endoscopic papillary balloon dilation (EPBD) utilizing a small balloon (< 10 mm) instead of EST for the removal of small CBD stones. In contrast, two cases of mortality due to post-ERCP pancreatitis (PEP) were reported after an EPBD clinical trial in the Western world, and the psychological barrier caused by these incidences hinders the use of this technique in Western countries. Endoscopic papillar large balloon dilation (EPLBD), which is used to treat large CBD stones, was not widely adopted when first introduced due to concerns about perforation and severe pancreatitis from the use of a large balloon (12-20 mm). However, as experience with this procedure accumulates, the occurrence of PEP with EPLBD is confirmed to be much lower than with EPBD. This report reviews whether EPBD and EPLBD, two procedures that use balloon dilation but differ in terms of indications and concept, contribute to the occurrence of PEP.
authors.affiliation: Sung Ill Jang, Department of Internal Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul 150-950, South Korea.
authors.forename: Sung Ill
authors.initials: SI
authors.lastname: Jang
authors.affiliation: Sung Ill Jang, Department of Internal Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul 150-950, South Korea.
authors.forename: Gak Won
authors.initials: GW
authors.lastname: Yun
authors.affiliation: Sung Ill Jang, Department of Internal Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul 150-950, South Korea.
authors.forename: Dong Ki
authors.initials: DK
authors.lastname: Lee
mesh_terms: D000208:Acute Disease; D057785:Catheters; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods / Q000401:mortality; D042883:Choledocholithiasis / Q000175:diagnosis / Q000628:therapy*; D004106:Dilatation / Q000009:adverse effects; D004867:Equipment Design; D006801:Humans; D010195:Pancreatitis / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality; D012307:Risk Factors; D012720:Severity of Illness Index; D016896:Treatment Outcome
keywords: Common bile duct stone; Endoscopic papillary balloon dilation; Endoscopic papillary large balloon dilation; Post-endoscopic retrograde cholangiopancreatography pancreatitis