Background Endoscopic papillary balloon dilation reduces sphincter function at least transiently or partially, which may allow pancreatobiliary and duodenobil iary reflux to occur. This study prospectively evaluated p...Background Endoscopic papillary balloon dilation reduces sphincter function at least transiently or partially, which may allow pancreatobiliary and duodenobil iary reflux to occur. This study prospectively evaluated pancreatobiliary and du odenobiliary reflux after endoscopic papillary balloon dilation. Methods In 12 p atients with choledocholithiasis, ductal bile was sampled for amylase concentrat ion and bacterial culture during ERCP,before and at 7 days to 5 years after endo scopic papillary balloon dilation. To provide comparative and control data, duct al bile was sampled in 12 patients with gallbladder cholesterol polyps and 6 wit h anomalous pancreaticobiliary junction who did not undergo endoscopic papillary balloon dilation. Results Amylase concentrations in ductal bile from patients w ith choledocholithiasis before endoscopic papillary balloon dilation were margin ally significantly higher (before Bonferroni correction) compared with concentra tions in bile from patients with gallbladder polyps. The concentration of amylas e in bile was significantly increased at 7 days after endoscopic papillary ballo on dilation compared with that before endoscopic papillary balloon dilation; the level was comparable with that of patients with an anomalous pancreaticobiliary junction. Subsequently,the amylase concentration gradually decreased and was ap proximately equal to the pre-endoscopic papillary balloon dilation level at 1 y ear. Bacteriocholia was frequent (67%-92%) for up to 3 months after endoscopi c papillary balloon dilation but was rare thereafter. Conclusions Endoscopic pap illary balloon dilation causes transient pancreatobiliary and duodenobili-ary r eflux. However, reflux is no longer present at 1 year after endoscopic papillary balloon dilation.展开更多
Background To determine whether endoscopic papillary balloon dilation decrease s the risk of hemorrhage without increasing the risk of acute pancreatitis, the results of endoscopic papillary balloon dilation were comp...Background To determine whether endoscopic papillary balloon dilation decrease s the risk of hemorrhage without increasing the risk of acute pancreatitis, the results of endoscopic papillary balloon dilation were compared with those of end oscopic biliary sphincterotomy in patients with cirrhosis and coagulopathy. Meth ods Twenty-one patients with liver cirrhosis with coagulopathy had endoscopic p apillary balloon dilation for choledocholithiasis from January 2001 to September 2003.Twenty patients with cirrhosis and coagulopathy who underwent endoscopic b iliary sphincterotomy from January 1998 to December 2000, served as a historical control group. Results The rate of endoscopic biliary sphincterotomy related he morrhage was 30%(6/20),whereas the rate for endoscopic papillary balloon dilati on related hemorrhage was 0%(p=0.009). With regard to rates of hemorrhage in re lation to Child-Pugh class,most (n=5) of the bleeding complications occurred in patients with Child-Pugh class C cirrhosis; bleeding occurred in only one pati ent with Child-Pugh B cirrhosis. There was no significant difference between th e endoscopic biliary sphincterotomy and the endoscopic papillary balloon dilatio n groups for procedure-related pancreatitis (10%vs. 4.7%, respectively; p >0. 05).Conclusions Endoscopic papillary balloon dilation may significantly reduce the risk of bleeding compa red with endoscopic biliary sphincterotomy in patients with advanced cirrhosis a nd coagulopathy. In these patients, the substitution of endoscopic papillary bal loon dilation for endoscopic biliary sphincterotomy is recommended for treatment of choledocholithiasis.展开更多
Background and Study Aim: Endoscopic papillary balloon dilation(EPBD) is assumed to have a theoretical advantage over endoscopic sphincterotomy (EST) in preserving sphincter of Oddi function because it does not involv...Background and Study Aim: Endoscopic papillary balloon dilation(EPBD) is assumed to have a theoretical advantage over endoscopic sphincterotomy (EST) in preserving sphincter of Oddi function because it does not involve cutting the biliary sphincter. Although attempts have been made to study the influence of EPBD and EST on sphincter of Oddi function,there is little agreement on this issue. In this study we used a method different from those described in previous reports to clarify whether EPBD or EST preserves sphincter of Oddi function better. Patients and Methods: 200 patients with bile duct stones who met the eligibility criteria were randomly assigned to EPBD (n = 104) or an EST (n = 96) group. Sphincter of Oddi function was estimated by measurement of the activity of pancreatic enzymes in the common bile duct (CBD). Pure bile was collected immediately before EPBD or EST, at 1 week and at 1 year after the procedure. We also statistically investigated 14 factors other than EPBD or EST that might have the potential to affect sphincter of Oddi function. Results: There was no significant difference between the baseline characteristics of the EPBD and EST groups. A total of 91 patients (46 in the EPBD group and 45 in the EST group) remained in the trial. Pure bile was collected from the CBD of 86 patients (43 EPBD and 43 EST) 1 week after the procedure. CBD stones were extracted successfully in all cases. Before the procedure,there were no significant differences in the levels of the five pancreatic enzymes between the EPBD and EST groups. At 1 week after the procedure, in both groups, there were significant increases in the levels of the five pancreatic enzymes. At 1year after the procedure a complete series of pancreatic enzyme analyses was done in 33 patients (12 EPBD and 21 EST). There was no significant difference between the levels of the five pancreatic enzymes immediately before and 1 year after EPBD and EST.When the pancreatic enzyme levels of the two groups were directly compared, there was no significant difference at 1 year after the procedure, but the EPBD group had significantly higher levels at 1 week following the procedure. Conclusion:In this study it was found that in patients with CBD stones both EPBD and EST preserve sphincter of Oddi function.展开更多
We prospectively studied long- term (5 years) effects of endoscopic papillar y balloon dilation (EPBD) on gallbladder motility. Thirteen patients with intact gallbladders (six with and seven without gallbladder stones...We prospectively studied long- term (5 years) effects of endoscopic papillar y balloon dilation (EPBD) on gallbladder motility. Thirteen patients with intact gallbladders (six with and seven without gallbladder stones) who had undergone EPBD for choledocholithiasis were enrolled in this study. Gallbladder volumes, w hile fasting and after dried egg yolk ingestion, were determined by ultrasonogra phy, before and at 7 days, 1 month, and 1, 2, and 5 years after EPBD. Before EPB D, the gallbladder had a larger fasting volume and lower yolk- stimulated maxim um contraction than in normal controls. Seven days after EPBD, fasting volume wa s decreased and maximum contraction was increased, regardless of whether the pat ient had gallbladder stones, showing significant differences from the pre- EPBD values. At 1 month to 5 years after EPBD, these changes were far less evident a nd gallbladder function did not differ significantly from baseline. EPBD does no t adversely affect gallbladder motility in the long- term (5 years).展开更多
文摘Background Endoscopic papillary balloon dilation reduces sphincter function at least transiently or partially, which may allow pancreatobiliary and duodenobil iary reflux to occur. This study prospectively evaluated pancreatobiliary and du odenobiliary reflux after endoscopic papillary balloon dilation. Methods In 12 p atients with choledocholithiasis, ductal bile was sampled for amylase concentrat ion and bacterial culture during ERCP,before and at 7 days to 5 years after endo scopic papillary balloon dilation. To provide comparative and control data, duct al bile was sampled in 12 patients with gallbladder cholesterol polyps and 6 wit h anomalous pancreaticobiliary junction who did not undergo endoscopic papillary balloon dilation. Results Amylase concentrations in ductal bile from patients w ith choledocholithiasis before endoscopic papillary balloon dilation were margin ally significantly higher (before Bonferroni correction) compared with concentra tions in bile from patients with gallbladder polyps. The concentration of amylas e in bile was significantly increased at 7 days after endoscopic papillary ballo on dilation compared with that before endoscopic papillary balloon dilation; the level was comparable with that of patients with an anomalous pancreaticobiliary junction. Subsequently,the amylase concentration gradually decreased and was ap proximately equal to the pre-endoscopic papillary balloon dilation level at 1 y ear. Bacteriocholia was frequent (67%-92%) for up to 3 months after endoscopi c papillary balloon dilation but was rare thereafter. Conclusions Endoscopic pap illary balloon dilation causes transient pancreatobiliary and duodenobili-ary r eflux. However, reflux is no longer present at 1 year after endoscopic papillary balloon dilation.
文摘Background To determine whether endoscopic papillary balloon dilation decrease s the risk of hemorrhage without increasing the risk of acute pancreatitis, the results of endoscopic papillary balloon dilation were compared with those of end oscopic biliary sphincterotomy in patients with cirrhosis and coagulopathy. Meth ods Twenty-one patients with liver cirrhosis with coagulopathy had endoscopic p apillary balloon dilation for choledocholithiasis from January 2001 to September 2003.Twenty patients with cirrhosis and coagulopathy who underwent endoscopic b iliary sphincterotomy from January 1998 to December 2000, served as a historical control group. Results The rate of endoscopic biliary sphincterotomy related he morrhage was 30%(6/20),whereas the rate for endoscopic papillary balloon dilati on related hemorrhage was 0%(p=0.009). With regard to rates of hemorrhage in re lation to Child-Pugh class,most (n=5) of the bleeding complications occurred in patients with Child-Pugh class C cirrhosis; bleeding occurred in only one pati ent with Child-Pugh B cirrhosis. There was no significant difference between th e endoscopic biliary sphincterotomy and the endoscopic papillary balloon dilatio n groups for procedure-related pancreatitis (10%vs. 4.7%, respectively; p >0. 05).Conclusions Endoscopic papillary balloon dilation may significantly reduce the risk of bleeding compa red with endoscopic biliary sphincterotomy in patients with advanced cirrhosis a nd coagulopathy. In these patients, the substitution of endoscopic papillary bal loon dilation for endoscopic biliary sphincterotomy is recommended for treatment of choledocholithiasis.
文摘Background and Study Aim: Endoscopic papillary balloon dilation(EPBD) is assumed to have a theoretical advantage over endoscopic sphincterotomy (EST) in preserving sphincter of Oddi function because it does not involve cutting the biliary sphincter. Although attempts have been made to study the influence of EPBD and EST on sphincter of Oddi function,there is little agreement on this issue. In this study we used a method different from those described in previous reports to clarify whether EPBD or EST preserves sphincter of Oddi function better. Patients and Methods: 200 patients with bile duct stones who met the eligibility criteria were randomly assigned to EPBD (n = 104) or an EST (n = 96) group. Sphincter of Oddi function was estimated by measurement of the activity of pancreatic enzymes in the common bile duct (CBD). Pure bile was collected immediately before EPBD or EST, at 1 week and at 1 year after the procedure. We also statistically investigated 14 factors other than EPBD or EST that might have the potential to affect sphincter of Oddi function. Results: There was no significant difference between the baseline characteristics of the EPBD and EST groups. A total of 91 patients (46 in the EPBD group and 45 in the EST group) remained in the trial. Pure bile was collected from the CBD of 86 patients (43 EPBD and 43 EST) 1 week after the procedure. CBD stones were extracted successfully in all cases. Before the procedure,there were no significant differences in the levels of the five pancreatic enzymes between the EPBD and EST groups. At 1 week after the procedure, in both groups, there were significant increases in the levels of the five pancreatic enzymes. At 1year after the procedure a complete series of pancreatic enzyme analyses was done in 33 patients (12 EPBD and 21 EST). There was no significant difference between the levels of the five pancreatic enzymes immediately before and 1 year after EPBD and EST.When the pancreatic enzyme levels of the two groups were directly compared, there was no significant difference at 1 year after the procedure, but the EPBD group had significantly higher levels at 1 week following the procedure. Conclusion:In this study it was found that in patients with CBD stones both EPBD and EST preserve sphincter of Oddi function.
文摘We prospectively studied long- term (5 years) effects of endoscopic papillar y balloon dilation (EPBD) on gallbladder motility. Thirteen patients with intact gallbladders (six with and seven without gallbladder stones) who had undergone EPBD for choledocholithiasis were enrolled in this study. Gallbladder volumes, w hile fasting and after dried egg yolk ingestion, were determined by ultrasonogra phy, before and at 7 days, 1 month, and 1, 2, and 5 years after EPBD. Before EPB D, the gallbladder had a larger fasting volume and lower yolk- stimulated maxim um contraction than in normal controls. Seven days after EPBD, fasting volume wa s decreased and maximum contraction was increased, regardless of whether the pat ient had gallbladder stones, showing significant differences from the pre- EPBD values. At 1 month to 5 years after EPBD, these changes were far less evident a nd gallbladder function did not differ significantly from baseline. EPBD does no t adversely affect gallbladder motility in the long- term (5 years).
