Placement of a metallic stent across the main duodenal papilla may predispose to cholangitis

Feasibility of placing a modified fully covered self-expandable metal stent above the papilla to minimize stent-induced bile duct injury in patients with refractory benign biliary strictures (with videos)

“…This may be a leading cause of cholangitis or de novo stone and sludge formation. 5,15 Tsujino et al 16 attempted the intraductal insertion of short plastic biliary stents containing a retrieval thread in 4 patients with benign biliary strictures after liver transplantation to prevent duodenobiliary reflux. However, 3 patients developed acute cholangitis, indicating a need to change the stent.…”

“…4 Stenting across to the papilla allows for easy reflux of duodenal contents. 5 We modified and evaluated the FCSEMS to create a novel stent for benign biliary strictures. A modified FCSEMS was intraductally placed through the strictured segment to minimize stent-induced complications.…”

Duodenal invasion is a risk factor for the early dysfunction of biliary metal stents in unresectable pancreatic cancer

“…18 Nonetheless, in most patients with pancreatic cancer, biliary obstruction develops near the papilla of Vater, and SEMSs should be placed with 1 end in the duodenum. In our study, the position of the distal stent edge was determined by the distance between the biliary stricture and the papilla, and the SEMS was placed above the papilla in only 5% of cases.…”

Complications of ERCP

“…7 Additionally, placement of self-expandable metal stents may increase the risk of cholecystitis, particularly if the stent is covered and the cystic duct is obstructed. [70][71][72] Prevention of infection Prophylactic antibiotics. Two meta-analyses failed to show the benefit of routine prophylactic antibiotic use in ERCP.…”