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Risks for papillary balloon dilation pancreatitis

The pathogenesis of pancreatitis after endoscopic papillary balloon dilation is unresolved, however, the unnecessary injection of contrast medium to the pancreas is associated with increased risk of pancreatitis, finds a report in January's American Journal of Gastroenterology.

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Endoscopic papillary balloon dilation has been accepted as a possible alternative to endoscopic sphincterotomy, especially in patients with impaired hemostasis.

However, pancreatitis associated with endoscopic papillary balloon dilation has remained a controversial, serious issue.

Dr Tsujino and colleagues from Tokyo, Japan undertook a study in order to investigate the risk factors for postendoscopic papillary balloon dilation pancreatitis in a single-center study.

The researchers recruited a total of 304 patients who all underwent endoscopic papillary balloon dilation for the management of common bile duct stones.

The researchers evaluated the risk of postendoscopic papillary balloon dilation pancreatitis and analyzed the risk factors by univariate and multivariate analysis.

Definition and grade of the severity of postendoscopic papillary balloon dilation pancreatitis were based on the 1991 consensus guidelines.

Procedure-related pancreatitis occurred in 5% of patients
The American Journal of Gastroenterology

The research team found that the common bile duct was cleared in 96% of patients.

The researchers noted that procedure-related pancreatitis occurred in 5% of patients where the grade was mild in 8 and moderate in 7.

The team revealed, by univariate analysis, 2 risk factors, stone diameter and contrast medium injection to the pancreas.

Finally, the researchers found that only the contrast medium injection to the pancreas was statistically significant by multivariate analysis.

Prior history of pancreatitis was identified as a risk factor for postendoscopic papillary balloon dilation pancreatitis in previous studies, but this factor was not identified as a risk factor in our series.

Dr Tsujino concluded, "Although the pathogenesis of pancreatitis after endoscopic papillary balloon dilation remains unresolved, the unnecessary injection of contrast medium to the pancreas can certainly be considered to be associated with the increased risk of pancreatitis."

The American Journal of Gastroenterology; 2005: 100 (1): 38-42
11 January 2005

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