A CASE OF ACUTE PANCREATITIS ASSOCIATED WITH COMMON BILE DUCT STONE REMOVAL BY ENDOSCOPIC PAPILLARY BALLOON DILATATION

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  • 内視鏡的乳頭バルーン拡張術による胆管結石除去後に発生した重症急性膵炎の１例

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Abstract

A 30-year-old male was hospitalized with general malaise and jaundice . MRCP showed a small stone in the distal common bile duct with minute stones in the gall bladder . On the next day the bile duct stone was removed employing endoscopic papillary balloon dilation (EPBD) using a 6-mm-diameter balloon with 4 to 6 atmospheres of pressure that was elevated slowly over two minutes. The disappearance of the notch sign in the bile duct was confirmed following the establishment of a 7 fr plastic stent ; stone extraction was performed using basket forceps and a retrieval balloon catheter. After the procedure, the patient developed acute pancreatitis. On day 1, serum and urinary amylases were 3, 120 and 903000 IU/L, respectively. The patient was saccessfully treated with continuous hemodiafiltration, as well as intra -arterial injections of protein inhibitors and antibiotics . EPBD is more conventional them EST, but it carries the potential risk of the patient developing acute pancreatitis . This, when an adaptation of EPBD is employed even by those with technical expertise, efforts should be made to avoid post-procedure acute pancreatitis.

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