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 Japan investigated the risk factors for postendoscopic papillary balloon dilation pancreatitis in a single-center study.
The research team enrolled a total of 304 patients who underwent endoscopic papillary balloon dilation for the management of common bile duct stones were enrolled.
The investigators evaluated the risk of postendoscopic papillary balloon dilation pancreatitis and the risk factors were analyzed by univariate and multivariate analysis.
| Stone diameter and contrast medium injection to the pancreas were identified as risk factors|
|American Journal of Gastroenterology|
The team based the definition and grade of the severity of postendoscopic papillary balloon dilation pancreatitis on the 1991 consensus guidelines.
The researchers found that common bile duct was cleared in 292 of 304 patients.
Procedure-related pancreatitis occurred in 15 patients where the grade was mild in 8 and moderate in 7.
The research team identified 2 risk factors using univariate analysis, namely stone diameter and contrast medium injection to the pancreas.
Only the contrast medium injection to the pancreas was statistically significant by multivariate analysis.
In addition, the investigators noted that prior history of pancreatitis as a risk factor for postendoscopic papillary balloon dilation pancreatitis in previous studies, but this factor was not identified as a risk factor in this series.
Dr Tsujino’s team concludes, “The pathogenesis of pancreatitis after endoscopic papillary balloon dilation remains unresolved.”
“However, the unnecessary injection of contrast medium to the pancreas can certainly be considered to be associated with the increased risk of pancreatitis.”