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Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jul 14, 2016; 22(26): 5909-5916
Published online Jul 14, 2016. doi: 10.3748/wjg.v22.i26.5909
Is endoscopic papillary balloon dilatation really a risk factor for post-ERCP pancreatitis?
Toshio Fujisawa, Koichi Kagawa, Kantaro Hisatomi, Kensuke Kubota, Atsushi Nakajima, Nobuyuki Matsuhashi
Toshio Fujisawa, Koichi Kagawa, Kantaro Hisatomi, Nobuyuki Matsuhashi, Department of Gastroenterology, NTT Medical Center Tokyo, Tokyo 141-8625, Japan
Kensuke Kubota, Atsushi Nakajima, Department of Gastroenterology and Hepatology, Yokohama City University School of Medicine, Yokohama 236-0027, Japan
Author contributions: Fujisawa T, Kubota K, Nakajima A and Matsuhashi N planned and designed the study; Fujisawa T, Kubota K, Hisatomi K and Kubota K performed the EPBD/EPLBD comparisons; Fujisawa T, Hisatomi K and Matsuhashi N wrote the manuscript; All authors approved the authorship.
Conflict-of-interest statement: No potential conflicts of interest. No financial support.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Toshio Fujisawa, MD, PhD, Department of Gastroenterology, NTT Medical Center Tokyo, 5-9-22 Higashi-Gotanda, Shinagawa, Tokyo 141-8625, Japan.
Telephone: +81-3-34486111 Fax: +81-3-34486541
Received: February 13, 2016
Peer-review started: February 13, 2016
First decision: March 21, 2016
Revised: March 23, 2016
Accepted: April 7, 2016
Article in press: April 7, 2016
Published online: July 14, 2016
Core Tip

Core tip: Some recent studies suggest that Endoscopic papillary balloon dilatation (EPBD) itself does not increase post-endoscopic retrograde cholangio-pancreatography (ERCP) pancreatitis (PEP) incidence. Theoretically, endoscopic papillary large-balloon dilatation (EPLBD) can damage the papilla more than EPBD does, but even direct EPLBD without preceding sphincterotomy does not increase PEP rate. An explanation for this paradox is that procedures following EPBD, but not EPBD itself, induce PEP. Since the EPBD stress is limited around the papilla, a prophylactic pancreatic stent could protect against the damage related to EPBD. EPBD has many advantages that endoscopic sphincterotomy does not. Therefore, it is time to re-evaluate the risks and efficacy of EPBD, and to utilize it suitably instead of shelving it.