title: Is endoscopic papillary balloon dilatation really a risk factor for post-ERCP pancreatitis?
abstract: Endoscopic papillary balloon dilatation (EPBD) is useful for decreasing early complications of endoscopic retrograde cholangio-pancreatography (ERCP), including bleeding, biliary infection, and perforation, but it is generally avoided in Western countries because of a relatively high reported incidence of post-ERCP pancreatitis (PEP). However, as the efficacy of endoscopic papillary large-balloon dilatation (EPLBD) becomes widely recognized, EPBD is attracting attention. Here we investigate whether EPBD is truly a risk factor for PEP, and seek safer and more effective EPBD procedures by reviewing past studies. We reviewed thirteen randomised control trials comparing EPBD and endoscopic sphincterotomy (EST) and ten studies comparing direct EPLBD and EST. Three randomized controlled trials of EPBD showed significantly higher incidence of PEP than EST, but no study of EPLBD did. Careful analysis of these studies suggested that longer and higher-pressure inflation of balloons might decrease PEP incidence. The paradoxical result that EPBD with small-calibre balloons increases PEP incidence while EPLBD does not may be due to insufficient papillary dilatation in the former. Insufficient dilatation could cause the high incidence of PEP through the use of mechanical lithotripsy and stress on the papilla at the time of stone removal. Sufficient dilation of the papilla may be useful in preventing PEP.
authors.affiliation: Toshio Fujisawa, Koichi Kagawa, Kantaro Hisatomi, Nobuyuki Matsuhashi, Department of Gastroenterology, NTT Medical Center Tokyo, Tokyo 141-8625, Japan.
authors.forename: Toshio
authors.initials: T
authors.lastname: Fujisawa
authors.affiliation: Toshio Fujisawa, Koichi Kagawa, Kantaro Hisatomi, Nobuyuki Matsuhashi, Department of Gastroenterology, NTT Medical Center Tokyo, Tokyo 141-8625, Japan.
authors.forename: Koichi
authors.initials: K
authors.lastname: Kagawa
authors.affiliation: Toshio Fujisawa, Koichi Kagawa, Kantaro Hisatomi, Nobuyuki Matsuhashi, Department of Gastroenterology, NTT Medical Center Tokyo, Tokyo 141-8625, Japan.
authors.forename: Kantaro
authors.initials: K
authors.lastname: Hisatomi
authors.affiliation: Toshio Fujisawa, Koichi Kagawa, Kantaro Hisatomi, Nobuyuki Matsuhashi, Department of Gastroenterology, NTT Medical Center Tokyo, Tokyo 141-8625, Japan.
authors.forename: Kensuke
authors.initials: K
authors.lastname: Kubota
authors.affiliation: Toshio Fujisawa, Koichi Kagawa, Kantaro Hisatomi, Nobuyuki Matsuhashi, Department of Gastroenterology, NTT Medical Center Tokyo, Tokyo 141-8625, Japan.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Nakajima
authors.affiliation: Toshio Fujisawa, Koichi Kagawa, Kantaro Hisatomi, Nobuyuki Matsuhashi, Department of Gastroenterology, NTT Medical Center Tokyo, Tokyo 141-8625, Japan.
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Matsuhashi
mesh_terms: D014670:Ampulla of Vater / Q000601:surgery*; D002760:Cholangiopancreatography, Endoscopic Retrograde; D042883:Choledocholithiasis / Q000601:surgery*; D004106:Dilatation; D006801:Humans; D008096:Lithotripsy; D010195:Pancreatitis / Q000453:epidemiology*; D011183:Postoperative Complications / Q000453:epidemiology*; D012307:Risk Factors; D016717:Sphincterotomy, Endoscopic
keywords: Endoscopic papillary balloon dilatation; Endoscopic papillary large-balloon dilatation; Endoscopic sphincterotomy; Post-endoscopic retrograde cholangio-pancreatography pancreatitis; Randomized controlled trial