Jjghm. Bergman et al., Is endoscopic balloon dilation for removal of bile duct stones associated with an increased risk for pancreatitis or a higher rate of hyperamylasemia?, ENDOSCOPY, 33(5), 2001, pp. 416-420
Background and Study Aims: We studied the rate of pancreatitis and asymptom
atic hyperamylasemia after endoscopic balloon dilation (EBD) and endoscopic
sphincterotomy (EST) for removal of bile duct stones,
Patients and Methods: Patients with bile duct stones of all sizes were rand
omly allocated to undergo EBD (8-mm dilation balloon) or EST, Pancreatitis
was defined as epigastric pain combined with at least a threefold rise in s
erum amylase at 24 hours after the endoscopic retrograde cholangiopancreato
graphy (ERCP), Asymptomatic hyperamylasemia was defined as a threefold rise
in serum amylase without epigastric pain,
Results: There were 180 patients (67 men, 113 women; mean age 67, SD 16.2)
available for analysis, Complete stone removal after a single ERCP was achi
eved in 82 (88 %) of 93 EBD patients and in 81 (93 %) of 87 EST patients (P
= 0.38), Mechanical lithotripsy was used more frequently in the EBD group
(31% vs, 13%, P = 0.005), Early complications occurred in 16 EBD patients (
17 %) and in 19 EST patients (22 %) (P = 0.46), Pancreatitis was observed i
n seven patients in each group (8 %), Logistic regression identified no sig
nificant predictors for the occurrence of pancreatitis, Asymptomatic hypera
mylasemia occurred in 21 EBD patients (23 %) vs seven EST patients (8 %) (P
= 0.008), Logistic regression identified EBD as the only significant predi
ctor for asymptomatic hyperamylasemia: odds ratio 2.9 (95 % confidence inte
rval (CI) 1.1 to 7.3, R-2 = 0.02),
Conclusions: We did not observe a difference in the rate of pancreatitis be
tween EBD and EST, Asymptomatic hyperamylasemia was observed more frequentl
y after EBD, Although asymptomatic hyperamylasemia is not a clinical entity
, this finding may indicate that EBD causes more irritation of the pancreas
than EST.