Pancreatitis after biliary stenting is increased in patients with proximal biliary strictures and prevented or treated by biliary sphincterotomy

P. R. Tarnasky, J. T. Cunningham, R. H. Hawes, B. J. Hoffman, R. Uflacker, I. Vujic, P. B. Cotton

Research output: Contribution to journalArticle

1 Scopus citations

Abstract

Background: Some experts question the need for sphincterotomy prior to biliary stenting as is commonly done; others advocate a biliary sphincterotomy to prevent stent-induced pancreatic ductal obstruction. The aim of the study was to determine the incidence of pancreatitis following biliary stent placement, and to investigate the potential protective role of sphincterotomy. Methods: 83 cases of initial transpapillary biliary stent placement (78 ERCP, 5 percutaneous) during a 1 yr interval were reviewed. The indication for stenting, stricture location (proximal or distal), sphincterotomy status, and incidence and severity of post-ERCP pancreatitis was determined. Proximal biliary strictures were defined as hilar, common hepatic duct, or mid common duct (if cystic duct not patent). Results: Post-procedure pancreatitis according to stricture location and whether a sphincterotomy was done at the time of stent placement is tabulated. Stricture Sphincterotomy Pancreatitis No Stricture N=13 YES 2 0 NO 11 0 Distal Stricture N=46 YES 15 0 NO 31 0 Proximal Stricture N=24 YES 11 0 NO 13 4 (31%) TOTAL N=83 4 (5%) Two cases were severe (1 fatal) and 2 were mild. One of the mild cases initially appeared to be significant but resolved quickly after a needle-knife sphincterotomy within 24hr of stent placement. Conclusions: The risk of pancreatitis after transpapiliary biliary stenting appears increased when the biliary obstruction is proximal. We hypothesize that stenting across a proximal biliary stenosis creates a fulcrum effect which predisposes to stent-induced pancreatic ductal obstruction. This may be prevented or treated by sphincterotomy.

Original languageEnglish (US)
Number of pages1
JournalGastrointestinal endoscopy
Volume43
Issue number4
DOIs
StatePublished - Jan 1 1996

    Fingerprint

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Gastroenterology

Cite this