Endoscopic papillary balloon dilation for bile duct stone: immediate and long-term outcomes in 1000 patients

Endoscopic papillary balloon dilatation in comparison with endoscopic sphincterotomy for the treatment of large common bile duct stone

BACKGROUND

There are concerns on the efficacy and safety of endoscopic papillary balloon dilatation (EPBD) as an alternative to endoscopic sphincterotomy (EST) in the treatment of choledocholithiasis. We compared the efficacy and safety of EPBD and EST for removing large common bile duct (CBD) stones.

MATERIALS AND METHODS

One hundred sixty patients with CBD stones of 10-20 mm were randomized to undergo EPBD or EST. A 15-mm dilatation balloon was used for EPBD. Cotton's criteria were used to determine the incidence of post-EPBD or post-EST complications. CBD stone removal and complications were compared between the two methods.

RESULTS

CBD stones were completely removed in 97.5% of the EPBD and 96.2% of the EST group (P = 0.5). The incidence of postoperative pancreatitis (11.2% vs 8.7%) and bleeding (1.2% vs 1.2%) were similar between the EPBD and EST groups (P > 0.05). Perforation did not occur in any patient.

CONCLUSIONS

EPBD with 15-mm dilator balloon appears to be equally safe and effective compared with EST for removal of large CBD stones. So because of low complication and high success rate we recommend EPBD as the preferred method for removal of large (10-20 mm) CBD stones.

Meta-analysis comparison of endoscopic papillary balloon dilatation and endoscopic sphincteropapillotomy

AIM: To assess endoscopic papillary balloon dilatation (EPBD) and endoscopic sphincteropapillotomy (EST) for common bile duct (CBD) stone removal using a meta-analysis.

METHODS: Randomized controlled trials published from 1990 to 2012 comparing EPBD with EST for CBD stone removal were evaluated. This meta-analysis was performed to estimate short-term and long-term complications of these two treatments. The fixed random effect model or random effect model was established to analysis the data. Results were obtained by analyzing the relative risk, odds ratio, and 95%CI for a given comparison using RevMan 5.1. Statistical significance was defined as P < 0.05. Risk of bias was evaluated using a funnel plot.

RESULTS: Of the 1975 patients analyzed, 980 of them were treated with EPBD and 995 were treated with EST. Of the patient population, patients in the EPBD group were younger (OR = -1.16, 95%CI: -1.49 to 0.84, P < 0.01). There were no significant differences in gender proportion, average size of stones, number of gallstones, previous cholecystectomy, the incidence of duodenal diverticulum, CBD diameter or the total follow-up time between EST and EPBD groups. Compared with EST, the total stone clearance in the EPBD group decreased (OR = 0.64, 95%CI: 0.42 to 0.96, P = 0.03), the use of stone extraction baskets significantly increased (OR = 1.91, 95%CI: 1.41 to 2.59, P < 0.01), and the incidence of pancreatitis significantly increased (OR = 2.79, 95%CI: 1.74 to 4.45, P < 0.0001). The incidence of bleeding (OR = 0.12, 95%CI: 0.04 to 0.34, P < 0.01) and cholecystitis (OR = 0.41, 95%CI: 0.20 to 0.84, P = 0.02) significantly decreased. The stone recurrence rate also was significantly reduced in EPBD (OR = 0.48, 95%CI: 0.26 to 0.90, P = 0.02). There were no significant differences between the two groups with the incidence of stone removal at first attempt, hours of operation, total short-term complications and infection, perforation, or acute cholangitis.

CONCLUSION: Although the incidence of pancreatitis was higher, the overall stone clearance rate and risk of bleeding was lower with EPBD compared to EST.

Long-term outcomes of endoscopic papillary balloon dilation and endoscopic sphincterotomy for bile duct stones

AIM

We recently reported that endoscopic papillary balloon dilation (EPBD) might suppress biliary bacterial contamination better than endoscopic sphincterotomy (EST) in patients with small bile duct stones (diameter ≤8 mm). In the present study, we evaluated immediate and long-term outcomes of endoscopic papillary balloon dilation with regard to stone size.

METHODS

We allocated 474 patients alternately to the two procedures. The patients were classified according to stone diameter (≤8 mm or >8 mm) and outcomes (i.e. complete stone removal, early complications, and late complications) were compared. The predictive risk factors for late complications were also investigated.

RESULTS

In patients with small stones, complete stone removal rate and early complication rate were similar between the two procedures; the incidence of pancreatitis was higher after EPBD, although the difference was not significant. Late complication rate and stone recurrence rate were significantly lower after EPBD than after EST (5.3% vs 17.3%, P = 0.009; 4.4% vs 12.7%; P = 0.048, respectively). In patients with large stones who underwent EPBD complete stone removal rate and late complication rate were lower, but the incidence of pancreatitis was higher. However, these differences were not statistically significant. Multivariate analysis showed that the increased risk of bactobilia following EPBD for large stones or EST, and the gallbladder with stones in situ were independent risk factors for late complications.

CONCLUSIONS

EPBD produced significantly better long-term outcomes than EST in patients with small bile duct stones.

Endoscopic papillary balloon dilation for removal of bile duct stones: evaluation of outcomes and complications in 298 patients

BACKGROUND

Endoscopic papillary balloon dilation (EPBD) is a therapeutic procedure for extraction of bile duct stones.

GOALS

To evaluate the therapeutic outcomes, postoperative complications, and associated risk factors of EPBD in patients with bile duct stones.

STUDY

A total of 298 patients with bile duct stones were treated with EPBD. Their immediate outcomes were assessed and they were followed up for late complications. The modified Cotton criteria were used to determine the incidence of post-EPBD pancreatitis.

RESULTS

Complete removal of bile duct stones was achieved in 273 patients (91.6%). Removal was successful in 94.6% of stones ≤ 1 cm and 82.9% of stones >1 cm (P=0.001). Thirty patients (10.1%) had acute pancreatitis after EPBD with bile duct stone extraction, including 20 women (P=0.044), 20 patients under 60 years old (P=0.003) and 19 who received contrast medium injection to the pancreas (P=0.016). Symptomatic bile duct stones recurred in 12 patients (4%) 1 to 65 months after EPBD. The duration of balloon dilation was >3 minutes in 11 of these 12 patients (P=0.025) and all recurrent stones were brown and black pigment stones.

CONCLUSIONS

EPBD is an effective and safe treatment for bile duct stone removal. Small bile duct stones (≤ 1 cm) can easily be extracted by EPBD. Contrast medium injection to the pancreas, female sex, and age under 60 years were significant risk factors for post-EPBD pancreatitis. Balloon dilatation duration >3 minutes was the only risk factor for recurrent symptomatic bile duct stones.

Endoscopic papillary balloon dilation for bile duct stones in patients on hemodialysis

BACKGROUND

Endoscopic papillary balloon dilation (EPBD) is a less hazardous alternative to endoscopic sphincterotomy for managing bile duct stones in patients with a coagulopathy. However, little information on EPBD is available for patients with bile duct stones who are undergoing hemodialysis (HD). We aimed to evaluate the safety and efficacy of EPBD for such patients.

PATIENTS

This was a retrospective cohort study with prospectively collected data for 37consecutive patients with bile duct stones who were undergoing HD and who also underwent EPBD between December 1995 and April 2010 at four institutions in Tokyo, Japan. The main outcome was the safety and efficacy of EPBD for managing bile duct stones in patients undergoing HD.

RESULTS

The bile duct stones were completely removed in one session in 24 patients (64.8%). Overall success was achieved using EPBD alone in all patients. Complications occurred in five patients (13.5%), including two with hemorrhage (5.4%). No hemorrhage developed in any of the 33 patients who had no additional bleeding risk except for HD. Pancreatitis and perforation developed in two (5.4%) and one (2.7%) patient, respectively.

CONCLUSIONS

EPBD seems to be a safe and effective treatment to extract bile duct stones in patients undergoing HD. However, EPBD should be performed carefully in patients with additional bleeding risk factors, such as Child-Pugh class C liver cirrhosis and those taking anti-platelet agents at the time of EPBD.

Endoscopic sphincterotomy plus balloon dilation for large bile duct stones: An analysis of 80 cases

AIM: To evaluate the therapeutic efficacy and safety of endoscopic sphincterotomy (EST) plus balloon dilation for large bile duct stones.

METHODS: Eighty patients with bile duct stones larger than 1.2 cm, who received endoscopic retrograde eholangiopancreatography (ERCP) from January 2010 to October 2011 at our hospital, were randomly and equally divided into two groups to receive EST and EST plus balloon dilation (ESBD), respectively. Balloon dilation was conducted after small EST in the ESBD group, while conventional EST was used in the EST group.

RESULTS: All stones were removed successfully from 36 patients (90%) of the EST group and 38 (95%) patients of the ESBD group. Mechanical lithotripsy was used to fragment stones in 15 (37.5%) EST procedures and 4 (10%) ESBD procedures. The operation time was longer in the EST group than in the ESBD group (41.78 ± 10.41 vs 36.28 ± 8.64, P < 0.05). Bleeding occurred in two patients of the EST group but not in patients of the ESBD group. Fever, abdominal pain, and acute pancreatitis developed in 1, 1 and 2 patients in the EST group, while abdominal pain and acute pancreatitis in 2 and 1 patients in the ESBD group, respectively. There is no significant difference in the incidence of early complications between the two groups (10% vs 7.5%, P > 0.05). No patient died.

CONCLUSION: ESBD is superior to EST in terms of operating time and the use of mechanical lithotripsy in managing large bile duct stones.

Fever-based antibiotic therapy for acute cholangitis following successful endoscopic biliary drainage

BACKGROUND

The current management of acute cholangitis consists of antibiotic therapy in combination with biliary drainage. However, the optimal duration of antibiotic therapy after the resolution of clinical symptoms by biliary drainage is unclear. We aimed to evaluate whether discontinuing antibiotic therapy for acute cholangitis immediately after the resolution of clinical symptoms, achieved by endoscopic biliary drainage, was safe and effective.

METHODS

This prospective study included patients with moderate and severe acute cholangitis. Cefmetazole sodium and meropenem hydrate were used as initial antibiotic therapy for patients with moderate and severe acute cholangitis, respectively. All patients underwent endoscopic biliary drainage within 24 h of diagnosis. When the body temperature of < 37 ° C was maintained for 24 h, administration of antibiotics was stopped. The primary endpoint was the recurrence of acute cholangitis within 3 days after the withdrawal of antibiotic therapy.

RESULTS

Eighteen patients were subjected to the final analysis. The causes of cholangitis were bile duct stone (n = 17) and bile duct cancer (n = 1). The severity of acute cholangitis was moderate in 14 patients and severe in 4. Body temperature of < 37 ° C was achieved in all patients after a median of 2 days (range 1-6) following endoscopic biliary drainage. Antibiotic therapy was administered for a median duration of 3 days (range 2-7). None of the patients developed recurrent cholangitis within 3 days after the withdrawal of antibiotics.

CONCLUSIONS

Fever-based antibiotic therapy for acute cholangitis is safe and effective when resolution of fever is achieved following endoscopic biliary drainage.

Effects of endoscopic papillary balloon dilation and endoscopic sphincterotomy on bacterial contamination of the biliary tract

BACKGROUND AND STUDY AIMS

Although endoscopic papillary balloon dilation (EPBD) has appeared with the expectation of better preserving sphincter of Oddi function than endoscopic sphincterotomy (EST), whether it can more effectively prevent bacterial contamination of the biliary tract than EST is controversial. To address this issue, we investigated the bacterial flora in the bile after the two procedures.

PATIENTS AND METHODS

Eighty-six patients were alternately allocated to EPBD or EST. Blood-liver function tests, ultrasonography, and endoscopic retrograde cholangiopancreatography were performed 6 months and 2 years after EPBD or EST, and the bile was sampled for bacterial culture during endoscopic retrograde cholangiopancreatography. Bactobilia and late complications were prospectively compared between the two procedures.

RESULTS

Overall, no significant difference was found in the incidence of bactobilia between EPBD and EST at the two examination points. Limiting stone diameter to 8 mm or less, there was a trend toward lower rate of bactobilia in the EPBD group 2 years later although the statistical significance disappeared after correction for multiple comparisons. The absence rate of late complications after EPBD was higher than that after EST, but there was no significant difference between the two procedures, both for the overall patients and for the patients with small stones.

CONCLUSION

EPBD has a possibility of suppressing bacterial contamination of the biliary tract compared with EST in patients with small stones. A large, long-term follow-up, randomized, controlled trial is necessary to clarify whether this benefit of EPBD reduces late complications.

Safety and long-term outcomes of endoscopic papillary balloon dilation in children with bile duct stones

BACKGROUND

Although experience with diagnostic and therapeutic ERCP in children is growing, little is known about the safety and technical outcomes of endoscopic papillary balloon dilation (EPBD) in pediatric patients with bile duct stones (BDSs).

OBJECTIVE

To assess the safety and long-term outcomes of EPBD in pediatric patients with BDSs.

DESIGN

Case study.

SETTING

Tertiary referral center.

PATIENTS AND INTERVENTIONS

This study involved 5 children who had BDSs combined with gallstones who underwent EPBD.

MAIN OUTCOME MEASUREMENTS

Successful EPBD, successful stone removal, procedure-related complications, and long-term outcomes.

RESULTS

ERCP was successful in all cases, with cannulation and subsequent EPBD. Stone removal was performed in 1 session in all patients. No EPBD-related complications were observed in any patient. After EPBD, 1 patient subsequently underwent laparoscopic cholecystectomy for gallstones. The remaining 4 were followed without surgery. In 2 patients, gallstones were spontaneously passed from the bile duct into the duodenum. During the follow-up period, over a mean of 7.1 years (range 3.7-9.3 years), no recurrence of BDSs was observed in any patient.

LIMITATIONS

Small number of patients.

CONCLUSIONS

Although BDSs are rare in pediatric patients, EPBD may be a safe and effective technique for the management of such stones in some children.

Long-term outcomes after endoscopic sphincterotomy versus endoscopic papillary balloon dilation for bile duct stones

OBJECTIVE

Endoscopic sphincterotomy (ES) is a well-established standard method for treating common bile duct stones. However, biliary sphincter function is impaired after the treatment, and this may influence the long-term outcomes. In this study, we aimed to compare the long-term outcomes after ES with those after endoscopic papillary balloon dilation (EPBD) because the latter procedure is expected to preserve biliary sphincter function better than ES.

DESIGN

A prospective follow-up of the original cohort in a previously randomized, controlled trial to compare the early outcomes after ES and EPBD.

SETTING

Eleven centers, including 6 clinical practices and 5 academic institutions.

PATIENTS

A total of 282 patients with common bile duct stones were randomly selected to undergo ES (n = 144) or EPBD (n = 138) in the previous study.

INTERVENTIONS

ES or EPBD.

MAIN OUTCOME MEASUREMENTS

Complications after ES or EPBD occurring during long-term follow-up.

RESULTS

The patients were followed up annually after the treatment. The median duration of the follow-up was 6.7 years. Morbidity was observed in 36 (25.0%) and 14 (10.1%) of the patients who underwent ES and EPBD, respectively (P = .0016). Kaplan-Meier analysis revealed a significantly higher incidence of biliary complications in the ES group than in the EPBD group (P = .0011). Multivariate analysis showed that ES, periampullary diverticulum, and in situ gallbladder stones were independent risk factors for stone recurrence.

CONCLUSIONS

During long-term follow-up, patients who underwent ES had significantly more biliary complications than those who underwent EPBD. The biliary sphincter dysfunction after ES results in additional late complications.

Endoscopic papillary balloon dilation for bile duct stone removal in patients 60 years old or younger

BACKGROUND

The aim of this study was to evaluate short- and long-term outcomes in relatively young patients (≤ 60 years old) who underwent endoscopic papillary balloon dilation (EPBD) for bile duct stone removal.

METHODS

Immediate and long-term outcomes were evaluated in 311 patients who were 60 years old or younger at the time of EPBD. The stone recurrence rate was compared among four groups stratified according to gallbladder (GB) status before and after EPBD (cholecystectomy after EPBD, GB left in situ with stones, GB left in situ without stones, and cholecystectomy before EPBD).

RESULTS

Bile duct stones were completely removed via EPBD alone in 304 patients (97.7%). Post-EPBD pancreatitis occurred in 24 patients (7.7%), and was mild in 18 patients, moderate in 5 patients, and severe in 1 patient. The rate of pancreatitis was significantly higher in these patients than in patients aged more than 60 years who underwent EPBD during the same study period (4.7%). Long-term outcomes were evaluated in 217 patients who were followed for at least 1 year after complete stone removal via EPBD. During a mean follow-up period of 5.6 years (range, 1.0-13.4 years), stone recurrence was observed in 13 patients (6.0%). The cumulative stone recurrence rates at 5 and 10 years after EPBD were 5.9 and 7.1%, respectively. Patients in the cholecystectomy after EPBD group had the lowest risk of stone recurrence among the four groups (2.0%).

CONCLUSION

EPBD removes bile duct stones in the majority of younger patients without increasing the risk of severe pancreatitis. Post-EPBD pancreatitis is more likely to occur in younger patients as compared to older patients. The long-term outcomes of EPBD appear favorable, especially in patients who have undergone cholecystectomy after EPBD.

The ballooning time in endoscopic papillary balloon dilation for the treatment of bile duct stones

BACKGROUND/AIMS

Endoscopic papillary balloon dilation (EPBD) is a safe and effective method for the treatment of choledocholithiasis, but previous studies have rarely reported the appropriate ballooning time (BT). We prospectively evaluated the safety and efficacy of EPBD according to BT in patients undergoing bile duct stone removal.

METHODS

Seventy consecutive patients with bile duct stones were randomly assigned to receive EPBD with either conventional (n = 35, 60 seconds) or short (n = 35, 20 seconds) BT.

RESULTS

EPBD alone achieved complete bile duct clearance in 67 patients (long BT, n = 33, 94.3%; short BT, n = 34, 97.1%; p = 0.808). We also found no significant difference in the rate of complete duct clearance, including procedures that used mechanical lithotripsy, between the long and short BT groups (97.1% vs. 100%; p = 0.811). Mild pancreatitis was noted in four (11.4%) patients in the long BT group and two (5.7%) patients in the short BT group, but this incidence was not significantly different.

CONCLUSIONS

The study showed that EPBD using both 20-sec and 60-sec BTs is safe and effective for the treatment of bile duct stones. Short and long BTs produced comparable outcomes.

Risk factors for recurrent bile duct stones after endoscopic papillary balloon dilation: long-term follow-up study

BACKGROUND

Little is known about the long-term results of endoscopic papillary balloon dilation (EPBD) for bile duct stones.

METHODS

Between 1995 and 2000, 204 patients with bile duct stones successfully underwent EPBD and stone removal. Complete stone clearance was confirmed using balloon cholangiography and intraductal ultrasonography (IDUS). Long-term outcomes of EPBD were investigated retrospectively in the year 2007, and risk factors for stone recurrence were multivariately analyzed.

RESULTS

Long-term information was available in 182 cases (89.2%), with a mean overall follow-up duration of 9.3 years. Late biliary complications occurred in 22 patients (12.1%), stone recurrence in 13 (7.1%), cholangitis in 10 (5.5%), cholecystitis in four, and gallstone pancreatitis in one. In 11 of 13 patients (84.6%), stone recurrence developed within 3 years after EPBD. All recurrent stones were bilirubinate. Multivariate analysis identified three risk factors for stone recurrence: dilated bile duct (>15 mm), previous cholecystectomy, and no confirmation of clean duct using IDUS.

CONCLUSION

Approximately 7% of patients develop stone recurrence after EPBD; however, retreatment with endoscopic retrograde cholangiopancreatography is effective. Careful follow up is necessary in patients with dilated bile duct or previous cholecystectomy. IDUS is useful for reducing stone recurrence after EPBD.

Management of late biliary complications in patients with gallbladder stones in situ after endoscopic papillary balloon dilation

OBJECTIVE

Patients with untreated gallbladder stones in situ are at high risk for late biliary complications after endoscopic papillary balloon dilation (EPBD) and bile duct stone extraction. Few data exist on the short-term and long-term results in these patients after the recurrence of bile duct stones and acute cholecystitis. The aim of this study was to evaluate the outcome of late biliary complications in patients with gallbladder stones in situ after EPBD.

METHODS

Fifty-six patients who developed late biliary complications, including bile duct stone recurrence (n=43) and acute cholecystitis (n=13), were managed at our institutions. We investigated the short-term and long-term outcomes after the management of late biliary complications.

RESULTS

Complete removal of recurrent bile duct stones was achieved in 38 of 43 patients (88%) by repeated EPBD alone. Pancreatitis after repeated EPBD occurred in two patients (5%). After successful bile duct stone extraction by EPBD, none of the 16 patients who underwent cholecystectomy developed late biliary complications (mean follow-up period of 5.2 years), wheras re-recurrent bile duct stones occurred in three of the 21 patients (14%) with gallbladder stones left in situ (mean follow-up period of 4.4 years)(P=0.1148). Re-recurrent bile duct stones were successfully treated endoscopically. One of the eight patients who did not undergo cholecystectomy for acute cholecystitis had a recurrence of cholecystitis, which was managed conservatively.

CONCLUSION

The long-term outcomes of late biliary complications are favorable when patients with concomitant gallbladder stones undergo cholecystectomy. Re-recurrent bile duct stones are considerable when gallbladder stones are left in situ, but should be treated endoscopically.

Endoscopic evaluation and therapies of biliary disorders

Biliary disorders were once only accessible by orthodox surgery but are now diagnosed and treated by multiple methods and specialists. Therapeutic endoscopic retrograde cholangiopancreatography has flourished and continues to grow after its introduction with the first biliary spincterotomies in 1974 in Germany and Japan. The therapeutic biliary endoscopist contributes to the management of all biliary disorders and in many cases endoscopy is the preferable approach. However, endoscopic retrograde cholangiopancreatography remains a risky procedure and risk is best reduced by strictly limiting its use.

Endoscopic papillary balloon dilation for the management of bile duct stones in patients 85 years of age and older

BACKGROUND

Endoscopic papillary balloon dilation (EPBD) is a possible alternative to endoscopic sphincterotomy for the treatment of bile duct stones. However, little information is available in the elderly.

OBJECTIVE

Our purpose was to evaluate the safety and efficacy of EPBD for bile duct stones in patients of 85 years of age and older.

DESIGN

Retrospective study from a single center.

SETTING

Tertiary care facility with experience in bile duct stone removal with EPBD.

PATIENTS

A total of 406 patients (74 patients >/=85 years old, group A; 332 patients <85 years old, group B) with bile duct stones underwent EPBD.

MAIN OUTCOME MEASUREMENTS

Efficacy and safety of EPBD between the 2 groups. Baseline patient characteristics were also evaluated.

RESULTS

The mean American Society of Anesthesiologists score in group A was significantly higher compared with that in group B (2.4 [0.5] vs 1.9 [0.7], P < .0001). Patients received anticoagulants more frequently and had larger and more numerous stones in group A than in group B with significant differences. Overall, bile duct clearance rates were similar in the 2 groups (91% vs 95%), but the mean number of sessions required for complete stone removal was significantly higher in group A (1.6 vs 1.4, P = .0081). The incidence of overall early complications after EPBD was lower in group A than in group B (2.7% vs 8.4%) but was not statistically different. None of the patients in group A had post-EPBD pancreatitis, whereas pancreatitis occurred in 5.7% in group B (P = .036). Bleeding was not observed after EPBD in 406 patients, including 7 patients in group A who received anticoagulation therapy at the time of EPBD. There was no significant difference in the cumulative stone nonrecurrence rate between group A and group B (log-rank test, P = .6225).

CONCLUSIONS

EPBD is a safe and effective technique for the treatment of bile duct stones even in high-risk elderly patients without an increased risk of pancreatitis and bleeding. Because the evaluation of outcomes might be biased by our study design (an open study), further studies are needed.

Intraductal US in the assessment of tumor involvement to the orifice of the cystic duct by malignant biliary obstruction

BACKGROUND

Tumor involvement to the orifice of the cystic duct (OCD) is a risk factor for cholecystitis after metallic stent (MS) placement.

OBJECTIVE

ERCP and intraductal US (IDUS) were used to assess tumor involvement to the OCD.

DESIGN

A prospective consecutive study.

SETTING

The University of Tokyo Hospital, Japan.

PATIENTS AND INTERVENTIONS

Between January 2003 and May 2007, 34 patients with resectable malignant biliary obstruction underwent an ERCP and an IDUS before preoperative biliary drainage.

MAIN OUTCOME MEASUREMENTS

ERCP and IDUS findings were confirmed via a histopathologic analysis of surgical specimens.

RESULTS

An ERCP showed that the cystic duct was opacified in 22 of 34 patients (64.7%). Eight patients were diagnosed with OCD tumor involvement. In the remaining 12 patients, tumor involvement was impossible to evaluate via an ERCP. An IDUS identified tumor involvement to the OCD in all 34 patients. Tumor involvement to the OCD was diagnosed in 12 patients, including 4 patients with previously negative results during an ERCP. Tumor involvement was confirmed by histopathology of surgical specimens. The sensitivity and specificity of detection were 66.7% (8/12) and 63.6% (14/22), respectively, via ERCP, and 100% (12/12) and 100% (22/22), respectively, via IDUS.

LIMITATION

The small sample size.

CONCLUSIONS

IDUS, in addition to ERCP, provides an accurate evaluation of tumor involvement to the OCD in patients with malignant biliary obstruction.

[Functional recovery of Oddi's sphincter after balloon dilatation of the papilla of Vater. An experimental study in rabbits]

INTRODUCTION

Balloon dilatation of the papilla of Vater is used to treat biliary lithiasis. The results and complications rate of this technique are excellent. Published data indicate that this procedure does not significantly alter the physiology of the sphincter of Oddi and that normal function is maintained. Papillary balloon dilatation would therefore provide an advantage over other techniques in which sphincteric function is abolished. The objective of this study was to evaluate the functional status of the sphincter of Oddi after balloon dilatation of the papilla of Vater.

MATERIAL AND METHODS

Twenty-four New Zealand albino rabbits were used. All animals underwent laparotomy and duodenotomy with balloon dilatation of the papilla of Vater. Manometric study of the biliary tract and of the sphincter of Oddi was also performed before, shortly after, and 21 days after dilatation. Biliary and sphincter of Oddi pressures and phasic activity of the sphincter (frequency, amplitude and duration of waves) were used as measuring variables for each of the stages of the experiment.

RESULTS

Papillary balloon dilatation immediately provoked substantial sphincter relaxation. Comparison of the values of basal biliary and sphincter of Oddi pressures with those found 21 days after dilatation showed no statistically significant differences. No significant differences were found when the variables related to phasic activity of the sphincter (frequency, amplitude and duration) were compared between the distinct phases of the experiment.

CONCLUSIONS

The results of the present study suggest complete recovery of sphincter function 21 days after balloon dilatation.

Incidence, risk factors, and prevention of post-ERCP pancreatitis

Pancreatitis is the most common complication of endoscopic retrograde cholangiopancreatography (ERCP). Because of the potential risks and consequences of post-ERCP pancreatitis, considerable efforts have been made to define patient- and procedure-related factors that may be associated with an increased risk of this complication, along with determining interventions that can be done to reduce post-ERCP pancreatitis.