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

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

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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)
Pages (from-to)399
Number of pages1
JournalGastrointestinal Endoscopy
Volume43
Issue number4
StatePublished - 1996
Externally publishedYes

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Pancreatitis
Pathologic Constriction
Stents
Endoscopic Retrograde Cholangiopancreatography
Cystic Duct
Common Hepatic Duct
Incidence
Needles

ASJC Scopus subject areas

  • Gastroenterology

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Pancreatitis after biliary stenting is increased in patients with proximal biliary strictures and prevented or treated by biliary sphincterotomy. / Tarnasky, P. R.; Cunningham, John T; Hawes, R. H.; Hoffman, B. J.; Uflacker, R.; Vujic, I.; Cotton, P. B.

In: Gastrointestinal Endoscopy, Vol. 43, No. 4, 1996, p. 399.

Research output: Contribution to journalArticle

Tarnasky, P. R. ; Cunningham, John T ; Hawes, R. H. ; Hoffman, B. J. ; Uflacker, R. ; Vujic, I. ; Cotton, P. B. / Pancreatitis after biliary stenting is increased in patients with proximal biliary strictures and prevented or treated by biliary sphincterotomy. In: Gastrointestinal Endoscopy. 1996 ; Vol. 43, No. 4. pp. 399.
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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.",
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AU - Tarnasky, P. R.

AU - Cunningham, John T

AU - Hawes, R. H.

AU - Hoffman, B. J.

AU - Uflacker, R.

AU - Vujic, I.

AU - Cotton, P. B.

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N2 - 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.

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