Topic Highlight
Copyright ©2014 Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Dec 7, 2014; 20(45): 16913-16924
Published online Dec 7, 2014. doi: 10.3748/wjg.v20.i45.16913
Balloon dilation itself may not be a major determinant of post-endoscopic retrograde cholangiopancreatography pancreatitis
Sung Ill Jang, Gak Won Yun, Dong Ki Lee
Sung Ill Jang, Department of Internal Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul 150-950, South Korea
Gak Won Yun, Dong Ki Lee, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 135-720, South Korea
Author contributions: Jang SI reviewed the literature, collected data, wrote and prepared the first draft of this manuscript; Yun GW reviewed the literature, collected data and prepared the tables of this review; and Lee DK designed, reviewed the literature, wrote, revised the paper and performed significant editing.
Correspondence to: Dong Ki Lee, MD, PhD, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonju-Ro, Gangnam-Gu, Seoul 135-720, South Korea.
Telephone: +82-2-20193214 Fax: + 82-2-34633882
Received: February 27, 2014
Revised: August 2, 2014
Accepted: September 12, 2014
Published online: December 7, 2014

Endoscopic retrograde cholangiopancreatography (ERCP) is the essential first modality for common bile duct (CBD) stone therapy. The conventional endoscopic treatment for CBD stones is stone removal after endoscopic sphincterotomy (EST). Stone removal after papillary stretching using balloon dilation instead of the conventional method has been widely adopted. There are many reports regarding endoscopic papillary balloon dilation (EPBD) utilizing a small balloon (< 10 mm) instead of EST for the removal of small CBD stones. In contrast, two cases of mortality due to post-ERCP pancreatitis (PEP) were reported after an EPBD clinical trial in the Western world, and the psychological barrier caused by these incidences hinders the use of this technique in Western countries. Endoscopic papillar large balloon dilation (EPLBD), which is used to treat large CBD stones, was not widely adopted when first introduced due to concerns about perforation and severe pancreatitis from the use of a large balloon (12-20 mm). However, as experience with this procedure accumulates, the occurrence of PEP with EPLBD is confirmed to be much lower than with EPBD. This report reviews whether EPBD and EPLBD, two procedures that use balloon dilation but differ in terms of indications and concept, contribute to the occurrence of PEP.

Keywords: Post-endoscopic retrograde cholangiopancreatography pancreatitis, Endoscopic papillary balloon dilation, Endoscopic papillary large balloon dilation, Common bile duct stone

Core tip: Endoscopic papillary balloon dilation (EPBD) and endoscopic papillary large balloon dilation (EPLBD) have been performed for removal of common bile duct stones. Although the rates of post-endoscopic retrograde cholangiopanc- reatography pancreatitis (PEP) after EPBD and EPLBD varied in many studies, the safety and feasibility of balloon dilation have been proven as results have accumulated. However, the exact mechanism of PEP after balloon dilation is unclear. The main determinant of severe PEP may be edema or spasm caused by irritation of the pancreatic orifice while performing difficult selective cannulation and struggling to remove the stone rather than balloon compression of the pancreatic flow.