Risk factors for acute pancreatitis after endoscopic papillary balloon dilation.

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.