Nakagawa Hiroshi, Ohara Kei
Gastrointestinal Unit, Komaki City Hospital, 1-20 Jyobushi Komaki, Aichi 485-8520, Japan.
J Hepatobiliary Pancreat Surg. 2006;13(2):75-9. doi: 10.1007/s00534-005-1061-5.
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.
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.
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%.
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.
背景/目的：内镜下乳头球囊扩张术（EPBD）是用于去除胆管结石的方法之一。尽管该手术存在引发急性胰腺炎的潜在风险，但EPBD可能保留Oddi括约肌的功能。关于降低EPBD中急性胰腺炎风险的尝试仅有少数报道。
我们对201例患者进行了EPBD以去除胆管结石。我们使用8毫米球囊，随后以5毫克/小时的速率滴注硝酸异山梨酯（ISDN）进行低压EPBD。观察十二指肠小乳头的功能、胆管中切迹征消失所需的充盈压力以及EPBD后的血清淀粉酶水平。
术后血清淀粉酶水平中位数为367 IU/l。两名患者（1.0%）发生急性胰腺炎。两名急性胰腺炎患者十二指肠小乳头功能差，切迹征消失所需的充盈压力高（超过5个大气压），球囊充盈期间腹痛严重；此外，手术耗时较长。胆管清除率为99.5%。
低压下球囊逐渐充盈，随后滴注ISDN的EPBD可降低与该手术相关的急性胰腺炎风险。十二指肠小乳头功能差、切迹征消失所需的高充盈压力、严重腹痛以及手术时间长会增加EPBD后急性胰腺炎的风险。
