Is endoscopic papillary balloon dilatation really a risk factor for post-ERCP pancreatitis?

Table 1 Pros and Cons of endoscopic papillary balloon dilatation

	Pros	Cons
Endoscopic papillary balloon dilatation1	Beginner-friendly	More pancreatitis?
	Less bleeding	Lower success rate of stone removal?
	Less perforation?
	Less biliary infection?
	Adaptive to altered anatomy
	Preserved sphincter function

¹Compared to endoscopic sphincterotomy.

Table 2 Endoscopic retrograde cholangio-pancreatography pancreatitis rates in endoscopic papillary balloon dilatation and endoscopic sphincterotomy in ramdomized control trials

Ref.		Study design	Year	Total patients	Significant difference from the control			Percentage of PEP		Balloon size (mm)	Maximum pressure (atm)	Ballooning time (s)	Dilatation speed	Note
					Therapuetic success	ML use	PEP rate	EPBD	EST
Significant	Fujita et al[33]	RCT	2003	282	-	-	EPBD > EST	10.9	2.8	8	Waist disappear	15	3 min
	Disario et al[2]	RCT	2004	237	-	-	EPBD > EST	10.3	0.8	8	Maximum	60	NM	2 deaths in EPBD
	Watanabe et al[34]	RCT	2007	180	EST > EPBD	EPBD > EST	EPBD > EST	16.7	6.7	8	7	120	NM
Non-significant	Minami et al[35]	RCT	1995	40	-	-	-	10.0	10.0	8	NM	180	NM	Manometry
	Bergman et al[36]	RCT	1997	202	-	EPBD > EST	-	6.9	6.9	8	12	45-60	1-2 min	1 death in EPBD
	Ochi et al[37]	RCT	1999	110	EST > EPBD	-	-	0	3.7	8	8	60 × 3 times	NM
	Arnold et al[38]	RCT	2001	60	EST > EPBD	NM	-	20.0	10.0	8	10	60 × 2 times	NM
	Yasuda et al[22]	RCT	2001	70	-	EPBD > EST	-	5.7	5.7	8	6	60 × 2 times	NM	Manometry
	Bergman et al[13]	RCT	2001	34	-	-	-	6.2	0	8	10	45-60	1-2 min	Billroth II
	Natsui et al[39]	RCT	2002	140	-	-	-	5.7	4.3	8	8	120	NM
	Vlavianos et al[40]	RCT	2003	202	-	-	-	4.8	1.0	10	12	30	NM
	Tanaka et al[41]	RCT	2004	32	-	-	-	18.8	18.8	8	8	120	NM	Long-term outcome
	Seo et al[25]	RCT	2014	132	-	-	-	8.1	7.1	6-10	Stone size	90-120	Gradually	Age < 40 yr

RCT: Randomized control trial; ML: Mechanical lithotripsy; NM: Not mentioned.

Table 3 Post-endoscopic retrograde cholangio-pancreatography pancreatitis rates after endoscopic papillary large-balloon dilatation without preceding endoscopic sphincterotomy

Ref.	Study design	Year	Total patients	Significance compared to the control			Percentage of PEP		Mean balloon size (mm)	Maximum pressure	Mean ballooning time (s)	Dilatation speed
				Therapuetic success	ML use	PEP rate	EPLBD alone	EST alone
Minakari et al[42]	RCT	2013	160	-	NM	-	11.2	8.7	15.0	Size of stones	60	NM
Kim et al[43]	R	2013	223	-	-	-	10.9	6.8	15.6	Waist disappear	38	With caution
Hwang et al[44]	R	2013	131	-	-	-	6.5	4.3	15.9	Size of stones	60	Gradually
Li et al[45]	R	2015	109	-	-	-	6.3	4.9	14.2	Size of stones	60	Gradually
Oh et al[46]	RCT	2012	83	-	-	-	5.0	7.0	11.8	Waist disappear	31	Gradually
Omuta et al[47]	Pros	2015	41	N/A	N/A	N/A	4.9	N/A	10-20	Size of stones	0	Gradually
Kogure et al[48]	Pros	2014	42	-	-	-	4.0	7.01	14.0	Waist disappear	15-60	Gradually
Jeong et al[49]	R	2009	38	N/A	N/A	N/A	2.6	N/A	15.5	Waist disappear	53	Gradually
Chan et al[50]	R	2011	247	N/A	N/A	N/A	0.8	N/A	13.2	Size of stones	282	NM
Lin et al[51]	RCT	2004	104	-	-	-	0	0	8-12	Size of stones	300	NM

¹Endoscopic papillary large-balloon dilatation (EPLBD) with preceding endoscopic sphincterotomy (EST). R: Retrospective; Pros: Prospective; RCT: Randomized controlled trial; ML: Mechanical lithotripsy; N/A: Not applicable; NM: Not mentioned.