The acute and long-term effect of balloon sphincteroplasty on papillary structure in pigs☆,☆☆,★
Section snippets
Animals
Sixteen healthy pigs (45 to 50 kg) were included in this investigation. Pigs were chosen because the biliary anatomy is comparable in size to humans; consequently, standard endoscopic biliary interventional equipment could be used. The study was approved by the Institutional Animal Care and Use Committee at Boston University Medical
RESULTS
Macroscopic and microscopic analysis showed the absence of a joint insertion for biliary and pancreatic ducts. Papillary lumen, mucosa (biliary and duodenal), lamina propria, muscularis mucosae, muscularis propria, and subserosa were identified in each specimen.
DISCUSSION
Concern regarding the short- and long-term sequelae of sphincterotomy in young patients undergoing ERCP stimulated our interest in balloon sphincteroplasty as a less traumatic alternative approach. Our results in patients have shown that balloon sphincteroplasty is safe and effective in over 80% of cases for clearance of bile duct stones less than 12 mm, with a minimal rate of pancreatitis.7, 8 Similar encouraging results have been reported by groups in Amsterdam and North Carolina.10, 11
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Cited by (71)
Comparable Long-term Outcomes of 1-Minute vs 5-Minute Endoscopic Papillary Balloon Dilation for Bile Duct Stones
2017, Clinical Gastroenterology and HepatologyBalloon Dilation With Adequate Duration Is Safer Than Sphincterotomy for Extracting Bile Duct Stones: A Systematic Review and Meta-analyses
2012, Clinical Gastroenterology and HepatologyCitation Excerpt :This meta-analysis contradicts the common belief that pancreatitis results from direct pancreatic duct compression during balloon dilation, and thus dilation duration should be short.2,12 Recent evidence suggests that EPBD with ≤1-minute dilatation carries a higher risk of inadequate sphincter loosening, which increases the risks of pancreatitis and failed stone extraction.13,32 The sphincter of Oddi surrounds ampulla and wraps around the distal end of the bile and pancreatic duct.33
Choledocholithiasis
2011, Clinical Gastrointestinal Endoscopy, Second EditionRandomized trial of 1-minute versus 5-minute endoscopic balloon dilation for extraction of bile duct stones
2010, Gastrointestinal EndoscopyEffects of large-balloon dilation on the major duodenal papilla and the lower bile duct: Histological evaluation by using an ex vivo adult porcine model
2010, Gastrointestinal EndoscopyCitation Excerpt :The resulting widely opened orifices and bile ducts support the usefulness of this procedure in removing large stones. Dilation to 8 mm did not result in obvious disruption of the bile duct, a result consistent with previous reports.11,12 Dilation to 10 mm also did not disrupt the bile duct in this study.
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From the Divisions of Gastroenterology & Surgery, Mallory Institute of Pathology, Boston University School of Medicine, Boston, Massachusetts.
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Reprint requests: P. Mac Mathuna, MD, Gastrointestinal Unit, Mater Misericordiae Hospital, University College Dublin, Eccles St., Dublin 7, Ireland.
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