Hepato-gastroenterology · 2003
Risk factors for acute pancreatitis after endoscopic papillary balloon dilation.
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Sugiyama Masanori, Abe Nobutsugu, Izumisato Yumi, Masaki Tadahiko, Mori Toshiyuki, Atomi Yutaka
Аннотация
BACKGROUND/AIMS: Although EPBD (endoscopic papillary balloon dilation) may cause acute pancreatitis, risk factors for post-EPBD pancreatitis have not been well described. We retrospectively analyzed risk factors predictive of acute pancreatitis after EPBD.
METHODOLOGY: A total of 101 patients underwent EPBD for choledocholithiasis. Post-EPBD acute pancreatitis was investigated. Nineteen potential risk factors, related to clinical characteristics or procedures, were retrospectively analyzed univariately and multivariately.
RESULTS: Bile duct clearance was achieved in 96 patients. Serum amylase was elevated after EPBD in 69 patients. Early complications occurred in 11 patients (11%); 5 had minimal (pain persisting for only 12-24 hours) and 6 mild (requiring 1-3 days of treatment) pancreatitis. These 11 patients showed at least a three-fold elevation of serum amylase. Multivariate analysis identified two independent risk factors for pancreatitis (prior history of acute pancreatitis, and bile duct diameter < or = 9 mm). The risk for post-EPBD pancreatitis was not associated with young age, pre-EPBD hyperamylasemia, large or multiple stones, periampullary diverticulum, pancreatic contrast injection, mechanical lithotripsy or residual stones.
CONCLUSIONS: Acute pancreatitis, usually mild or minimal, can be anticipated after EPBD for bile duct stones in approximately 10% of patients. In those with previous pancreatitis or a non-dilated bile duct, special care is necessary given the high incidence of pancreatitis.
METHODOLOGY: A total of 101 patients underwent EPBD for choledocholithiasis. Post-EPBD acute pancreatitis was investigated. Nineteen potential risk factors, related to clinical characteristics or procedures, were retrospectively analyzed univariately and multivariately.
RESULTS: Bile duct clearance was achieved in 96 patients. Serum amylase was elevated after EPBD in 69 patients. Early complications occurred in 11 patients (11%); 5 had minimal (pain persisting for only 12-24 hours) and 6 mild (requiring 1-3 days of treatment) pancreatitis. These 11 patients showed at least a three-fold elevation of serum amylase. Multivariate analysis identified two independent risk factors for pancreatitis (prior history of acute pancreatitis, and bile duct diameter < or = 9 mm). The risk for post-EPBD pancreatitis was not associated with young age, pre-EPBD hyperamylasemia, large or multiple stones, periampullary diverticulum, pancreatic contrast injection, mechanical lithotripsy or residual stones.
CONCLUSIONS: Acute pancreatitis, usually mild or minimal, can be anticipated after EPBD for bile duct stones in approximately 10% of patients. In those with previous pancreatitis or a non-dilated bile duct, special care is necessary given the high incidence of pancreatitis.