Digestive Disease Center and Research Institute, Department of Internal Medicine, Soon Chun Hyang University School of Medicine, Bucheon and Seoul, Korea.
J Gastroenterol Hepatol. 2013 Aug;28(8):1416-21. doi: 10.1111/jgh.12277.
The mechanism of pancreatitis development following endoscopic papillary balloon dilation (EPBD) remains unknown. Antegrade dilation with percutaneous transhepatic papillary balloon dilation (PTPBD) allows the removal of bile duct stones or fragments during percutaneous choledochoscopic lithotomy, with less mechanical trauma to the papilla than with EPBD-mediated stone removal.
A total of 56 patients with bile duct stones underwent antegrade dilation with PTPBD from March 2006 to February 2011. A total of 208 patients with common bile duct stones underwent retrograde dilation with EPBD during the same period. The conditions of papillary balloon dilation were identical in both groups. The frequencies of pancreatitis and hyperamylasemia were compared in both groups.
Pancreatitis occurred in 14 (6.7%) of 208 patients in the EPBD group (mild, nine; moderate, four; severe, one). There was no case of pancreatitis among 56 patients in the PTPBD group (P < 0.05). Hyperamylasemia developed in significantly more patients treated in the EPBD group (62, 29.8%) compared with the PTPBD group (4, 7.1%; P < 0.05). Complete bile duct clearance was achieved in 98.2% of PTPBD group and 97.1% of EPBD group.
The rates of post-procedural pancreatitis and hyperamylasemia were significantly higher after retrograde dilation with EPBD than after antegrade dilation with PTPBD for the removal of bile duct stones. Although the mechanism of pancreatitis following papillary balloon dilation remains unclear, post-EPBD pancreatitis may be associated with procedures before and after balloon dilation similar to mechanical lithotripsy rather than balloon dilation itself.
内镜乳头球囊扩张（EPBD）后胰腺炎发展的机制尚不清楚。经皮经肝胆道镜取石术（PTCD）的顺行扩张允许在经皮胆管镜碎石术时取出胆管结石或碎片，对乳头的机械创伤比 EPBD 介导的结石清除术小。
2006 年 3 月至 2011 年 2 月，56 例胆管结石患者采用经皮经肝胆道镜顺行扩张行 PTPBD。同期 208 例胆总管结石患者行逆行扩张 EPBD。两组乳头球囊扩张条件相同。比较两组胰腺炎和高淀粉酶血症的发生率。
EPBD 组 208 例患者中发生胰腺炎 14 例（6.7%）（轻度 9 例；中度 4 例；重度 1 例）。PTPBD 组 56 例患者中无胰腺炎病例（P < 0.05）。EPBD 组高淀粉酶血症患者明显多于 PTPBD 组（62 例，29.8%）（P < 0.05）。PTPBD 组完全清除胆管率为 98.2%，EPBD 组为 97.1%。
与经皮经肝胆道镜取石术顺行扩张相比，逆行扩张 EPBD 治疗胆管结石后胰腺炎和高淀粉酶血症的发生率明显升高。尽管乳头球囊扩张后胰腺炎的机制尚不清楚，但 EPBD 后胰腺炎可能与球囊扩张前后的机械碎石术类似，而与球囊扩张本身无关。
