Background-Endoscopic papillary balloon dilatation (EPBD) has been reported as a safe and eVective alternative to endoscopic sphincterotomy in the management of common bile duct (CBD) stones; its eVect on papillary function has yet to be elucidated. Aim-To investigate sphincter of Oddi (SO) motility before and after EPBD to determine its eVect on SO function. Patients and methods-The papillary function of 10 patients with CBD stones was studied using endoscopic manometry before and one week after EPBD. The manometric studies were repeated one month after EPBD in seven patients. Results-One week after EPBD, CBD pressure, SO peak pressure, SO basal pressure, and SO frequency decreased significantly. One month after EPBD, however, all parameters increased although the increases in SO basal pressure and CBD pressure were not significant. There was no significant diVerence in values of any parameter before and one month after EPBD. No serious complications occurred. Conclusion-These data suggest at least partial recovery of papillary function one month after the procedure. EPBD seems to preserve papillary function in treatment of CBD stones; a longer term follow up study with SO manometry should be performed to clarify the eVect of EPBD on SO function. (Gut 1997; 41: 541-544) Keywords: endoscopic papillary balloon dilatation; sphincter of Oddi Endoscopic sphincterotomy (EST) is widely accepted as an eVective procedure for removing common bile duct (CBD) stones. There is however concern that EST may alter the structure and motor function of the sphincter of Oddi (SO) for a long period of time in young patients having laparoscopic cholecystectomy.1 2 Endoscopic papillary balloon dilatation (EPBD) has been proposed as a less invasive alternative for CBD stone management.1-4 Based on animal studies, EPBD is expected to preserve papillary smooth muscle integrity in humans. 5 In this study, we investigated SO motility before and after EPBD to determine its eVect on SO function up to one month after the procedure. Patients and MethodsTen patients (five women and five men; mean age 70 years, range 52-92 years) undergoing EPBD for removal of CBD stones were studied. No patient had had any upper abdominal operation before EPBD. Although five patients had simultaneous gall bladder stones, all refused cholecystectomy mainly because of their age. Before EPBD, patients underwent SO manometry studies and endoscopic retrograde cholangiography (ERC) at the same session. The same sequence was used for the study one week after EPBD in all patients. One month later, only the manometric study was repeated, with measurement of CBD diameter by ultrasound image, in seven patients. Manometry was performed before ERC, and pharyngeal topical anaesthesia (lidocaine spray) was given prior to SO manometry.6-8 A 4-French microtransducer catheter (Gaeltec Ltd, Dunvegam, Isle of Skye, Scotland, UK) was inserted into the CBD through a biopsy channel of the duodenofibrescope (Olympus JF200 or TJF20, Olympus, Tokyo, Japan), and fluoroscopy w...

Pancreaticopleural fistulas are a rare complication of acute or chronic pancreatitis, and are usually treated by surgery. We report three patients whose pancreaticopleural fistulas were successfully treated by endoscopic retrograde cholangiopancreatography and drainage (stenting, nasopancreatic drainage). In one patient a pancreatic pseudocyst persisted despite successful initial closure of the leak using this method and, as it was also suspected to be infected, additional drainage of the pseudocyst was required. Endotherapy of pancreaticopleural fistulas could obviate the need for surgery when conventional medical treatment has failed in this condition.

Low birth weight has been associated with cardiovascular diseases. The waist-to-height ratio is a good indicator of risks for these diseases. The objective of this study was to examine the associations between birth weight and adult waist-to-height ratio in a Japanese population. A cross-sectional study, comprised of 851 subjects (401 men and 450 women) aged 35-62 years who were born at full term, was conducted at a medical checkup. The subjects responded to a questionnaire about weight at birth, and data on physical characteristics were collected from the results of the medical checkup. The subjects were stratified with sex and a Body Mass Index of 25 kg/m 2 to elucidate the effects of birth weight on adult waist-to-height ratio. Analysis of covariance was used to compare the physical condition among the 4 birth weight categories. After adjusting for age, alcohol consumption, smoking status and exercise, the height was significantly lower in the birth weight < 2,500 g category among men (P < 0.001) and women (P < 0.001), while the waist-to-height ratio was significantly higher in the birth weight < 2,500 g category, compared with the > 3,500 g category in the non-obese women (P = 0.004), but not in the obese women. In conclusion, low birth weight was independently associated with a low adult height among men and women and with a high adult waist-to-height ratio among non-obese women. Our results suggest that intrauterine environmental insults might lead to accumulation of visceral fat among non-obese women.

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It is well established that prostaglandins (PGs) exert potent pharmacological actions on vascular and nonvascular smooth muscle, although their effects on the sphincter of Oddi (SO) remain to be elucidated. The aim of this study was to investigate the effect of PGE1 on motility of the human SO. Twenty patients appearing for routine endoscopic retrograde cholangiopancreatography (ERCP) examination were studied. Each patient was randomly allocated to receive an intravenous infusion of normal saline (six patients), or alprostadil alfadex, a synthetic PGE1 analog, at a dose of either 0.05 or 0.1 microg/kg/min (seven patients for each condition). Endoscopic biliary manometry was done with a recording of basal SO pressure, amplitude of SO phasic contractions, and phasic contractile frequency before and 5 min after intravenous infusions, using a 4-French microtransducer catheter. There was no significant change in SO motor variables following application of normal saline. Alprostadil alfadex significantly decreased basal SO pressure at a dose of 0.05 microg/kg/min, and significantly decreased all parameters at a dose of 0.1 microg/kg/min. A synthetic PGE1 analog, alprostadil alfadex, effectively inhibits motility of the human SO. This drug may be of clinical application as a SO-relaxing agent.