Abstract
Background/Purpose
Endoscopic papillary balloon dilatation (EPBD) is one of the methods used to remove bile duct stones. EPBD may preserve the function of the sphincter of Oddi in spite of the potential risk of acute pancreatitis caused by the procedure. There are only few reports of attempts to reduce the risk of acute pancreatitis in EPBD.
Methods
We performed EPBD for bile duct stone removal in 201 patients. We used an 8-mm balloon followed by drip infusion of isosorbide dinitrate (ISDN) at a rate of 5 mg/h for low-pressure EPBD. The function of the minor duodenal papilla, the inflation pressure required for the disappearance of the notch sign in the bile duct, and the serum amylase level after EPBD were observed.
Results
The median serum amylase level after the procedure was 367 IU/l. Acute pancreatitis occurred in two patients (1.0%). The two patients with acute pancreatitis had poor function of the minor duodenal papilla, a high inflation pressure (over 5 atm) required for disappearance of the notch, sign, and severe abdominal pain during balloon inflation; as well, the procedure took a long time. The rate of duct clearance was 99.5%.
Conclusions
EPBD with gradual inflation of the balloon at a low pressure, followed by ISDN drip infusion, could decrease the risk of acute pancreatitis associated with the procedure. Poor function of the minor duodenal papilla, high inflation pressure required for disappearance of the notch, sign, severe abdominal pain, and a lengthy procedure increase the risk of acute pancreatitis after EPBD.
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References
PB Cotton G Lehman J Vennes et al. (1991) ArticleTitleEndoscopic sphincterotomy complications and their management: an attempt at consensus Gastrointest Endosc 37 383–93 Occurrence Handle1:STN:280:By6A3c7kt1M%3D Occurrence Handle2070995
ML Freeman DB Nelson S Sherman et al. (1996) ArticleTitleComplications of endoscopic biliary sphincterotomy N Engl J Med 335 909–18 Occurrence Handle10.1056/NEJM199609263351301 Occurrence Handle1:STN:280:BymA28rislE%3D Occurrence Handle8782497
M Staritz K Ewe KH Meyer zum Buschenfelde (1983) ArticleTitleEndoscopic papillary dilation (EPD) for the treatment of common bile duct stones and papillary stenosis Endoscopy 15 197–8 Occurrence Handle6872989
M Bader JE Greenen WJ Hogan WJ Dodds R Venu GK Johnson (1986) ArticleTitleEndoscopic balloon dilatation of the sphincter of Oddi in patients with suspected biliary dyskinesia; results of a prospective randomized trial (abstract) Gastrointest Endosc 32 158
RA Kozarek (1988) ArticleTitleBalloon dilatation of the sphincter of Oddi Endoscopy 20 207–10 Occurrence Handle3168949
RM Gary PB Cotton E Simon et al. (1993) ArticleTitleRemoval of stones from the bile duct at ERCP without sphincterotomy Gastrointest Endosc 39 749–54
PM Mathuna P White E Clarke et al. (1995) ArticleTitleEndoscopic balloon sphincteroplasty (papillary dilatation) for bile duct stones: efficacy, safety and follow up in 100 patients Gastrointest Endosc 42 468–74 Occurrence Handle10.1016/S0016-5107(95)70052-8 Occurrence Handle1:STN:280:BymC2cbms1w%3D Occurrence Handle8566640
Y Komatsu T Kawabe N Toda et al. (1998) ArticleTitleEndoscopic papillary balloon dilatation for the management of common bile duct stones: experience of 226 cases Endoscopy 30 12–7 Occurrence Handle1:STN:280:DyaK1c3gvFamug%3D%3D Occurrence Handle9548037
JJGHM Bergmann EAJ Rauws P Fockens et al. (1997) ArticleTitleRandomized trial of endoscopic balloon dilation versus endoscopic sphincterotomy for removal of bile duct stones Lancet 349 1124–9
P Needleman PB Corr EM Johnson (1985) Drugs used for the treatment of angina AG Gilman LS Goodman TW Rall F Murad (Eds) The pharmacological basis of therapeutics EditionNumber7th ed. Macmillan New York 806–16
GS Bergh (1942) ArticleTitleThe sphincter mechanism of the common bile duct in human subjects Surgery 11 299–330
IM Herling (1984) ArticleTitleIntravenous nitroglycerin: clinical pharmacology and therapeutic considerations Am Heart J 108 141–9 Occurrence Handle10.1016/0002-8703(84)90557-X Occurrence Handle1:STN:280:BiuB38fhs1w%3D Occurrence Handle6428205
M Staritz (1988) ArticleTitlePharmacology of the sphincter of Oddi Endoscopy 20 171–4 Occurrence Handle3049055
M Staritz T Poralla K Ewe et al. (1985) ArticleTitleEffect of glyceryl trinitrate on the sphincter of Oddi motility and baseline pressure Gut 26 194–7 Occurrence Handle1:STN:280:BiqC3c3ptFI%3D Occurrence Handle3917965
Y Ibuki M Kudo A Todo (1992) ArticleTitleEndoscopic retrograde extraction of common bile duct stones with drip infusion of isosorbide dinitrate Gastrointest Endosc 38 178–80 Occurrence Handle1:STN:280:By2B3svhslI%3D Occurrence Handle1568616
H Nakagawa (2004) ArticleTitleComparing balloon diameter on performing endoscopic papillary balloon dilatation with isosorbide dinitrate drip infusion for removal of bile duct stones Dig Endosc 16 289–94
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Nakagawa, H., Ohara, K. Safeguards against acute pancreatitis associated with endoscopic papillary balloon dilatation. J Hepatobiliary Pancreat Surg 13, 75–79 (2006). https://doi.org/10.1007/s00534-005-1061-5
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DOI: https://doi.org/10.1007/s00534-005-1061-5