Prospective Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Oct 16, 2016; 8(18): 663-668
Published online Oct 16, 2016. doi: 10.4253/wjge.v8.i18.663
Prior minimal endoscopic sphincterotomy to prevent pancreatitis related to endoscopic balloon sphincteroplasty
Ryo Kanazawa, Jin Kan Sai, Tomoyasu Ito, Hiroko Miura, Shigeto Ishii, Hiroaki Saito, Ko Tomishima, Ryo Shimizu, Koki Sato, Manabu Hayashi, Sumio Watanabe, Shuichiro Shiina
Ryo Kanazawa, Jin Kan Sai, Tomoyasu Ito, Hiroko Miura, Shigeto Ishii, Hiroaki Saito, Ko Tomishima, Ryo Shimizu, Koki Sato, Manabu Hayashi, Sumio Watanabe, Shuichiro Shiina, Department of Gastroenterology, Juntendo University School of Medicine, Tokyo 113-8421, Japan
Author contributions: Kanazawa R and Sai JK contributed equally to this work; Kanazawa R collected and analyzed the data, and drafted the manuscript; Sai JK provided analytical oversightand designed and supervised the study; Watanabe S and Shiina S revised the manuscript for the important intellectual content; Ito T, Miura H, Ishii S, Saito H, Tomishima K, Shimizu R, Sato K and Hayashi M supported collecting the data; all authors have read and approved the final version to be published.
Institutional review board statement: This study was approved by the Institutional Review Board of Juntendo University.
Clinical trial registration statement: In the study period (October 2010 - March 2014), clinical trial registration was not required for our prospective study.
Informed consent statement: Written informed consent for the procedures and treatment was obtained from patients or their next of kin in accordance with normal clinical practice.
Conflict-of-interest statement: No conflict of interests.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at jinkans@juntendo.ac.jp. Participants gave informed consent was not obtained but the presented data are anonymized and risk of identification is low.
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: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Jin Kan Sai, MD, Department of Gastroenterology, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan. jinkans@juntendo.ac.jp
Telephone: +81-3-58021061 Fax: +81-3-56845960
Received: February 2, 2016
Peer-review started: February 9, 2016
First decision: March 23, 2016
Revised: July 18, 2016
Accepted: August 6, 2016
Article in press: August 8, 2016
Published online: October 16, 2016
Processing time: 254 Days and 2.7 Hours
Abstract
AIM

To investigate the efficacy of prior minimal endoscopic sphincterotomy (EST) to prevent pancreatitis related to endoscopic balloon sphincteroplasty (EBS).

METHODS

After bile duct access was gained and cholangiogram confirmed the presence of stones < 8 mm in the common bile duct at endoscopic retrograde cholangiography, patients were subjected to minimal EST (up to one-third of the size the papilla) plus 8 mm EBS (EST-EBS group). The incidence of pancreatitis and the difference in serum amylase level after the procedure were examined and compared with those associated with 8-mm EBS alone in 32 patients of historical control (control group).

RESULTS

One hundred and five patients were included in the EST-EBS group, and complete stone removal was accomplished in all of them. The difference in serum amylase level after the procedure was - 25.0 (217.9) IU/L in the EST-EBS group and this value was significantly lower than the 365.5 (576.3) IU/L observed in the control group (P < 0.001). The incidence of post-procedure pancreatitis was 0% (0/105) in the EST-EBS group and 15.6% (5/32) in the control group (P < 0.001).

CONCLUSION

Prior minimal EST might be useful to prevent the elevation of serum amylase level and the occurrence of pancreatitis related to EBS.

Keywords: Choledocholithiasis; Adverse event; Pancreatitis; Endoscopic sphincterotomy; Endoscopic balloon sphincteroplasty

Core tip: We evaluated the efficacy of prior minimal endoscopic sphincterotomy (EST) to prevent pancreatitis related to endoscopic balloon sphincteroplasty (EBS). One hundred and five patients with bile duct stones < 8 mm were subjected to minimal EST (up to one-third of the size the papilla) plus 8 mm EBS (EST-EBS group). The incidence of pancreatitis and the difference in serum amylase level after the procedure were examined and compared with those associated with 8-mm EBS alone in 32 patients of historical control (control group). The difference in serum amylase level after the procedure in the EST-EBS group was significantly lower than that observed in the control group (P < 0.001). The incidence of post-procedure pancreatitis was 0% (0/105) in the EST-EBS group and 15.6% (5/32) in the control group (P < 0.001).