Pancreatic stenting prevents pancreatitis after biliary sphincterotomy in patients with sphincter of Oddi dysfunction

P. R. Tarnasky, Y. Y. Palesch, John T Cunningham, P. D. Mauldin, P. B. Cotton, R. H. Hawes

Research output: Contribution to journalArticle

327 Citations (Scopus)

Abstract

Background and Aims: Patients with sphincter of Oddi dysfunction are at high risk of developing pancreatitis after endoscopic biliary sphincterotomy. Impaired pancreatic drainage caused by pancreatic sphincter hypertension is the likely explanation for this increased risk. A prospective, randomized controlled trial was conducted to determine if ductal drainage with pancreatic stenting protects against pancreatitis after biliary sphincterotomy in patients with pancreatic sphincter hypertension. Methods: Eligible patients with pancreatic sphincter hypertension were randomized to groups with pancreatic duct stents (n = 41) or no stents (n = 39) after biliary sphincterotomy. The primary measured outcome was pancreatitis after endoscopic retrograde cholangiopancreatography (ERCP). Results: Pancreatic stenting significantly decreased the risk of pancreatitis from 26% to 7% (10 of 39 in the no stent group and 3 of 41 in the stent group; P = 0.03). Only 1 patient in the stent group developed pancreatitis after sphincterotomy, and 2 others developed pancreatitis at the time of stent extraction. Patients in the no stent group were 10 times more likely to develop pancreatitis immediately after sphincterotomy than those in the stent group (relative risk, 10.5; 95% confidence interval, 1.4-78.3). Conclusions: Pancreatic duct stenting protects significantly against post-ERCP pancreatitis in patients with pancreatic sphincter hypertension undergoing biliary sphincterotomy. Stenting of the pancreatic duct should be strongly considered after biliary sphincterotomy for sphincter of Oddi dysfunction; pancreatic sphincter of Oddi manometry identifies which high-risk patients may benefit from pancreatic stenting.

Original languageEnglish (US)
Pages (from-to)1518-1524
Number of pages7
JournalGastroenterology
Volume115
Issue number6
StatePublished - 1998
Externally publishedYes

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Sphincter of Oddi Dysfunction
Pancreatitis
Stents
Pancreatic Ducts
Hypertension
Endoscopic Retrograde Cholangiopancreatography
Drainage
Sphincter of Oddi
Endoscopic Sphincterotomy
Manometry
Randomized Controlled Trials
Confidence Intervals

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Tarnasky, P. R., Palesch, Y. Y., Cunningham, J. T., Mauldin, P. D., Cotton, P. B., & Hawes, R. H. (1998). Pancreatic stenting prevents pancreatitis after biliary sphincterotomy in patients with sphincter of Oddi dysfunction. Gastroenterology, 115(6), 1518-1524.

Pancreatic stenting prevents pancreatitis after biliary sphincterotomy in patients with sphincter of Oddi dysfunction. / Tarnasky, P. R.; Palesch, Y. Y.; Cunningham, John T; Mauldin, P. D.; Cotton, P. B.; Hawes, R. H.

In: Gastroenterology, Vol. 115, No. 6, 1998, p. 1518-1524.

Research output: Contribution to journalArticle

Tarnasky, PR, Palesch, YY, Cunningham, JT, Mauldin, PD, Cotton, PB & Hawes, RH 1998, 'Pancreatic stenting prevents pancreatitis after biliary sphincterotomy in patients with sphincter of Oddi dysfunction', Gastroenterology, vol. 115, no. 6, pp. 1518-1524.
Tarnasky, P. R. ; Palesch, Y. Y. ; Cunningham, John T ; Mauldin, P. D. ; Cotton, P. B. ; Hawes, R. H. / Pancreatic stenting prevents pancreatitis after biliary sphincterotomy in patients with sphincter of Oddi dysfunction. In: Gastroenterology. 1998 ; Vol. 115, No. 6. pp. 1518-1524.
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AU - Palesch, Y. Y.

AU - Cunningham, John T

AU - Mauldin, P. D.

AU - Cotton, P. B.

AU - Hawes, R. H.

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N2 - Background and Aims: Patients with sphincter of Oddi dysfunction are at high risk of developing pancreatitis after endoscopic biliary sphincterotomy. Impaired pancreatic drainage caused by pancreatic sphincter hypertension is the likely explanation for this increased risk. A prospective, randomized controlled trial was conducted to determine if ductal drainage with pancreatic stenting protects against pancreatitis after biliary sphincterotomy in patients with pancreatic sphincter hypertension. Methods: Eligible patients with pancreatic sphincter hypertension were randomized to groups with pancreatic duct stents (n = 41) or no stents (n = 39) after biliary sphincterotomy. The primary measured outcome was pancreatitis after endoscopic retrograde cholangiopancreatography (ERCP). Results: Pancreatic stenting significantly decreased the risk of pancreatitis from 26% to 7% (10 of 39 in the no stent group and 3 of 41 in the stent group; P = 0.03). Only 1 patient in the stent group developed pancreatitis after sphincterotomy, and 2 others developed pancreatitis at the time of stent extraction. Patients in the no stent group were 10 times more likely to develop pancreatitis immediately after sphincterotomy than those in the stent group (relative risk, 10.5; 95% confidence interval, 1.4-78.3). Conclusions: Pancreatic duct stenting protects significantly against post-ERCP pancreatitis in patients with pancreatic sphincter hypertension undergoing biliary sphincterotomy. Stenting of the pancreatic duct should be strongly considered after biliary sphincterotomy for sphincter of Oddi dysfunction; pancreatic sphincter of Oddi manometry identifies which high-risk patients may benefit from pancreatic stenting.

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