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...

We reviewed the current status of transnasal esophagogastroduodenoscopy (EGD) with regard to tolerance, safety, feasibility and accuracy. Comparison of standard and ultrathin scopes and recently reported endoscopic techniques with transnasal insertion are also described as well as the current status of transnasal EGD in European countries compared with Japan.As several studies concluded that transnasal EGD can facilitate comfortable endoscopy without the need for sedative drugs, it has been tried in countries in which a relatively high number of unsedated EGD are carried out in daily practice. Long-tube intubation of the jejunum with the assistance of transnasal EGD will also be a part of the daily practice in the near future. However, its safety and accuracy should be further investigated. Even a standard scope whose charge-coupled device (CCD) has the same resolution as an ultrathin scope is superior to an ultrathin scope in terms of luminosity and resolution. Given the small number of procedures reported to date, the absolute complication rate of unsedated transnasal EGD is unknown. Methods of nasal anesthesia, as well as informed consent, indications and contraindications for transnasal EGD are not standardized. A guideline of transnasal EGD is under discussion by the Japanese Gastroenterological Endoscopy Society.

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