Association between insufficient balloon dilatation during endoscopic papillary balloon dilatation and post-ERCP pancreatitis in patients with choledocholithiasis: a multicentre retrospective study in China.

OBJECTIVES

To determine whether insufficient balloon dilatation during endoscopic papillary balloon dilatation (EPBD) is associated with postendoscopic retrograde cholangiopancreatography pancreatitis (PEP) and prolonged hospitalisation and to identify clinical and anatomical factors related to insufficient dilatation.

DESIGN

Multicentre retrospective cohort study with propensity score matching analysis.

SETTING

Three tertiary referral hospitals in China: Union Hospital of Tongji Medical College of Huazhong University of Science and Technology, the Gastroenterology and Endoscopy Center of the First Affiliated Hospital of Sun Yat-Sen University and the First Affiliated Hospital of Shihezi University.

PARTICIPANTS

Among 3341 patients with choledocholithiasis who underwent EPBD between January 2023 and December 2024, 2970 met the eligibility criteria. After 1:1 propensity score matching, 220 patients were included in the final analysis, including 110 with inadequate balloon dilatation and 110 with adequate dilatation.

PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome was the incidence of PEP, diagnosed by standardised criteria. Secondary outcomes included the length of postoperative hospitalisation and risk factors for insufficient balloon dilatation.

RESULTS

The incidence of PEP was significantly higher in the insufficient dilatation group compared with the sufficient dilatation group (24.5% vs 8.2%, p=0.002). Multivariate analysis confirmed insufficient dilatation as an independent risk factor for PEP (OR 4.302, 95% CI 1.874 to 9.879, p=0.001), while endoscopic nasobiliary drainage (ENBD) was a protective factor (OR 0.391, 95% CI 0.178 to 0.858, p=0.019). Insufficient dilatation was also associated with a longer postoperative hospital stay (p=0.002). Furthermore, the presence of a juxtapapillary duodenal diverticulum (JDD) was strongly correlated with a lower likelihood of insufficient dilatation (OR 0.388, 95% CI 0.210 to 0.716, p=0.002).

CONCLUSIONS

Insufficient balloon dilatation during EPBD is a significant risk factor for PEP. ENBD was associated with a reduced risk. Patients with JDD are more likely to achieve sufficient balloon dilatation. Recognising this sign of insufficient dilatation can help clinicians stratify risk and tailor postprocedural management.