Does leaving a main pancreatic duct stent in place reduce the incidence of precut biliary sphincterotomy (ES)-induced pancreatitis? a final analysis of a randomized prospective study

Safety and Success of Precut Biliary Sphincterotomy: Is it Linked to Experience or Expertise

“…A study by Harewood and Baron reporting a precut complication rate of 15% (out of 253 PBS procedures) attributes their higher number of complications in part to a lack of PD stent placement [11] . Sherman et al [15] reported a complication rate of 14% in their unstented controls compared with a 2% rate of pancreatitis in patients with a PD stent placed. In our study, a PD stent was used in 48% of the procedures in group 5, compared with an average of 23% of the time in the other five groups.…”

“…Several studies have identified SOD as a risk factor for pancreatitis following both ES and PBS [5,15,19] . The small number of SOD patients requiring PBS in our study (1/150) is one explanation for the low complication rate.…”

“…If this method failed, a glidewire was next used in combination with a sphincterotome to attempt selective biliary cannulation (Boston Scientific, Natick, MA). If selective cannulation was still unsuccessful, precut sphincterotomy was then attempted using a standard needle-knife with pure cutting current with or without prior placement of a pancreatic duct stent [4,15] . The precut method used was similar to the technique described by Mavrogiannis for the removal of CBD stones [16] .…”

“…Many of the concerns about PBS among experts, however, were based on findings from early studies [12][13][14] . Although multiple studies have shown that PBS carries a higher risk when performed by a less experienced endoscopist, reported complication rates from PBS are not significantly different than from standard sphincterotomy in most tertiary care centers [4,7,9,15] . Given the varied success and complication rates, we sought to evaluate these outcomes of PBS based on prior training and experience, and also to compare the complication rates of PBS to ES.…”

Prevention of post-ERCP pancreatitis

“…These include the duration a stent should remain in place to be effective, the damage it may cause to the pancreatic duct, spontaneous dislodgement or removal of the stent, and the stent design (35). In four (36)(37)(38)(39) fully published works and two abstracts, totaling six prospective randomized controlled trials, the rate of PEP significantly decreased following pancreatic duct stent placement (40,41). In two casecontrolled trials (42,43) and one retrospective analysis (44), pancreatic stent placement decreased the incidence of PEP.…”