Endoscopic Sphincterotomy Before Deployment of Covered Metal Stent is Associated With Greater Complication Rate

Abstract

Deployment of covered SEMS without prior ES in patients with distal common bile duct obstruction owing to pancreatic cancer is feasible and prevents the development of complications such as stent migration, bleeding, and perforation.

Nitinol biliary stent versus surgery for palliation of distal malignant biliary obstruction

“…In fact, no patient in the stent group experienced obstructive pancreatitis. Findings show that even when the pancreatic duct is intact, the addition of endoscopic sphincterotomy may prevent obstructive pancreatitis but increase stent migration [27].…”

Overview of ERCP Complications: Prevention and Management

“…Certain high-risk procedures including precut sphincterotomy or access papillotomy, balloon dilation of the bile duct especially without a biliary sphincterotomy, pancreatic sphincterotomy, and any pancreatic duct interventions are consistently associated with increased risk by multivariable analyses. Although there has remained concern over increased rates of pancreatitis with metal biliary stent placement, several studies including a small randomized trial failed to confirm this with uncovered and partially covered metal stents, [7][8][9] and biliary sphincterotomy before stent placement did not impact PEP. Despite these data, concern remains over potentially increased pancreatitis with use of fully covered metal stents.…”

An Update to Hepatobiliary Stents

“…While 48% of the patients with sphincterotomy experienced complications, only 10% of patients without sphincterotomy experienced complications. 39 Banerjee et al looked at 104 patients retrospectively that required biliary drainage for pancreaticobiliary malignancies and found that patients who underwent biliary sphincterotomy during transpapillary SEMS placement experienced more complications without increased duration in stent patency. 42 Moss et al performed a metaanalysis on 1,454 people and showed sphincterotomy-related complications in 24% of patients that underwent SEMS for obstructing pancreatic carcinoma.…”

“…However, several RCTs have shown that biliary sphincterotomy is not necessary when placing a single plastic or metal biliary stent. [39][40][41][42] Giorgio et al looked retrospectively at 172 patients with malignant common bile duct (CBD) obstruction and showed that sphincterotomy was not necessary for successful placement of 10F plastic stents. Half of the patients had sphincterotomy prior to the placement of stents while the other half did not.…”

“…40 Artifon et al looked at sphincterotomy before SEMS in patients with malignant CBD obstruction from pancreatic cancer. 39 He randomly assigned 74 patients to biliary stenting with or without sphincterotomy. cSEMS were placed in all patients.…”