Prior minimal endoscopic sphincterotomy to prevent pancreatitis related to endoscopic balloon sphincteroplasty.
OBJECTIVE
To investigate the efficacy of prior minimal endoscopic sphincterotomy (EST) to prevent pancreatitis related to endoscopic balloon sphincteroplasty (EBS).


METHODS
After bile duct access was gained and cholangiogram confirmed the presence of stones < 8 mm in the common bile duct at endoscopic retrograde cholangiography, patients were subjected to minimal EST (up to one-third of the size the papilla) plus 8 mm EBS (EST-EBS group). The incidence of pancreatitis and the difference in serum amylase level after the procedure were examined and compared with those associated with 8-mm EBS alone in 32 patients of historical control (control group).


RESULTS
One hundred and five patients were included in the EST-EBS group, and complete stone removal was accomplished in all of them. The difference in serum amylase level after the procedure was - 25.0 (217.9) IU/L in the EST-EBS group and this value was significantly lower than the 365.5 (576.3) IU/L observed in the control group (P< 0.001). The incidence of post-procedure pancreatitis was 0% (0/105) in the EST-EBS group and 15.6% (5/32) in the control group (P< 0.001).


CONCLUSIONS
Prior minimal EST might be useful to prevent the elevation of serum amylase level and the occurrence of pancreatitis related to EBS.
Ryo Kanazawa, Jin Kan Sai, Tomoyasu Ito, Hiroko Miura, Shigeto Ishii, Hiroaki Saito, Ko Tomishima, Ryo Shimizu, Koki Sato, Manabu Hayashi, Sumio Watanabe, Shuichiro Shiina, Department of Gastroenterology, Juntendo University School of Medicine, Tokyo 113-8421, Japan.
Ryo
R
Kanazawa
Ryo Kanazawa, Jin Kan Sai, Tomoyasu Ito, Hiroko Miura, Shigeto Ishii, Hiroaki Saito, Ko Tomishima, Ryo Shimizu, Koki Sato, Manabu Hayashi, Sumio Watanabe, Shuichiro Shiina, Department of Gastroenterology, Juntendo University School of Medicine, Tokyo 113-8421, Japan.
Jin Kan
JK
Sai
Ryo Kanazawa, Jin Kan Sai, Tomoyasu Ito, Hiroko Miura, Shigeto Ishii, Hiroaki Saito, Ko Tomishima, Ryo Shimizu, Koki Sato, Manabu Hayashi, Sumio Watanabe, Shuichiro Shiina, Department of Gastroenterology, Juntendo University School of Medicine, Tokyo 113-8421, Japan.
Tomoyasu
T
Ito
Ryo Kanazawa, Jin Kan Sai, Tomoyasu Ito, Hiroko Miura, Shigeto Ishii, Hiroaki Saito, Ko Tomishima, Ryo Shimizu, Koki Sato, Manabu Hayashi, Sumio Watanabe, Shuichiro Shiina, Department of Gastroenterology, Juntendo University School of Medicine, Tokyo 113-8421, Japan.
Hiroko
H
Miura
Ryo Kanazawa, Jin Kan Sai, Tomoyasu Ito, Hiroko Miura, Shigeto Ishii, Hiroaki Saito, Ko Tomishima, Ryo Shimizu, Koki Sato, Manabu Hayashi, Sumio Watanabe, Shuichiro Shiina, Department of Gastroenterology, Juntendo University School of Medicine, Tokyo 113-8421, Japan.
Shigeto
S
Ishii
Ryo Kanazawa, Jin Kan Sai, Tomoyasu Ito, Hiroko Miura, Shigeto Ishii, Hiroaki Saito, Ko Tomishima, Ryo Shimizu, Koki Sato, Manabu Hayashi, Sumio Watanabe, Shuichiro Shiina, Department of Gastroenterology, Juntendo University School of Medicine, Tokyo 113-8421, Japan.
Hiroaki
H
Saito
Ryo Kanazawa, Jin Kan Sai, Tomoyasu Ito, Hiroko Miura, Shigeto Ishii, Hiroaki Saito, Ko Tomishima, Ryo Shimizu, Koki Sato, Manabu Hayashi, Sumio Watanabe, Shuichiro Shiina, Department of Gastroenterology, Juntendo University School of Medicine, Tokyo 113-8421, Japan.
Ko
K
Tomishima
Ryo Kanazawa, Jin Kan Sai, Tomoyasu Ito, Hiroko Miura, Shigeto Ishii, Hiroaki Saito, Ko Tomishima, Ryo Shimizu, Koki Sato, Manabu Hayashi, Sumio Watanabe, Shuichiro Shiina, Department of Gastroenterology, Juntendo University School of Medicine, Tokyo 113-8421, Japan.
Ryo
R
Shimizu
Ryo Kanazawa, Jin Kan Sai, Tomoyasu Ito, Hiroko Miura, Shigeto Ishii, Hiroaki Saito, Ko Tomishima, Ryo Shimizu, Koki Sato, Manabu Hayashi, Sumio Watanabe, Shuichiro Shiina, Department of Gastroenterology, Juntendo University School of Medicine, Tokyo 113-8421, Japan.
Koki
K
Sato
Ryo Kanazawa, Jin Kan Sai, Tomoyasu Ito, Hiroko Miura, Shigeto Ishii, Hiroaki Saito, Ko Tomishima, Ryo Shimizu, Koki Sato, Manabu Hayashi, Sumio Watanabe, Shuichiro Shiina, Department of Gastroenterology, Juntendo University School of Medicine, Tokyo 113-8421, Japan.
Manabu
M
Hayashi
Ryo Kanazawa, Jin Kan Sai, Tomoyasu Ito, Hiroko Miura, Shigeto Ishii, Hiroaki Saito, Ko Tomishima, Ryo Shimizu, Koki Sato, Manabu Hayashi, Sumio Watanabe, Shuichiro Shiina, Department of Gastroenterology, Juntendo University School of Medicine, Tokyo 113-8421, Japan.
Sumio
S
Watanabe
Ryo Kanazawa, Jin Kan Sai, Tomoyasu Ito, Hiroko Miura, Shigeto Ishii, Hiroaki Saito, Ko Tomishima, Ryo Shimizu, Koki Sato, Manabu Hayashi, Sumio Watanabe, Shuichiro Shiina, Department of Gastroenterology, Juntendo University School of Medicine, Tokyo 113-8421, Japan.
Shuichiro
S
Shiina
Adverse event; Choledocholithiasis; Endoscopic balloon sphincteroplasty; Endoscopic sphincterotomy; Pancreatitis