BACKGROUND: Endoscopic transpapillary biliary stent placement is effective for closure of postoperative bile leaks. Large-bore stents (10 French) may transiently obstruct the adjacent pancreatic duct orifice causing acute pancreatitis. Endoscopic biliary sphincterotomy may reduce this risk, but it introduces separate risks of bleeding and perforation. The objective of this study was to compare complications after large-bore biliary stent placement (10 Fr) with and without sphincterotomy in patients with bile leaks. METHODS: The institutional endoscopy database was queried to identify patients who had undergone endoscopic retrograde cholangiopancreatogrpahy (ERCP) for bile leak between March 1996 and August 2006. Procedural reports were reviewed for evidence of biliary sphincterotomy, cholangiographic and pancreatographic findings, transpapillary stent placement, and procedural complications. Patients with prior biliary sphincterotomy, choledochoenteric anastomosis, placement of multiple biliary stents and expandable metal biliary stents, biliary stents smaller than 10 Fr, and patients in whom a stent was not placed were excluded. The chi-square test was used for categorical variables. Probability <or= 0.05 was considered significant. RESULTS: The rate of pancreatitis (all mild) after large-bore biliary stent placement was greater when sphincterotomy was not performed than when sphincterotomy and stent placement were both performed (13% versus 2.4%). This difference was not statistically significant. (Chi(2) = 3.41; p = 0.1). Bleeding was observed in one patient who underwent sphincterotomy and large-bore stent placement (2.4%). No perforations occurred in either group. CONCLUSIONS: Although not statistically significant, there is a higher rate of post-ERCP pancreatitis after placement of large-bore biliary stents when sphincterotomy is not performed. The additional complications of biliary sphincterotomy did not offset the reduction in post-ERCP pancreatitis. When large-bore biliary stents are used in the treatment of bile leak, a biliary sphincterotomy may avoid pancreatitis. Randomized trials are needed to determine whether there is a significant difference in overall complication rate when large-bore stents are placed with and without biliary sphincterotomy.
BACKGROUND: Endoscopic transpapillary biliary stent placement is effective for closure of postoperative bile leaks. Large-bore stents (10 French) may transiently obstruct the adjacent pancreatic duct orifice causing acute pancreatitis. Endoscopic biliary sphincterotomy may reduce this risk, but it introduces separate risks of bleeding and perforation. The objective of this study was to compare complications after large-bore biliary stent placement (10 Fr) with and without sphincterotomy in patients with bile leaks. METHODS: The institutional endoscopy database was queried to identify patients who had undergone endoscopic retrograde cholangiopancreatogrpahy (ERCP) for bile leak between March 1996 and August 2006. Procedural reports were reviewed for evidence of biliary sphincterotomy, cholangiographic and pancreatographic findings, transpapillary stent placement, and procedural complications. Patients with prior biliary sphincterotomy, choledochoenteric anastomosis, placement of multiple biliary stents and expandable metal biliary stents, biliary stents smaller than 10 Fr, and patients in whom a stent was not placed were excluded. The chi-square test was used for categorical variables. Probability <or= 0.05 was considered significant. RESULTS: The rate of pancreatitis (all mild) after large-bore biliary stent placement was greater when sphincterotomy was not performed than when sphincterotomy and stent placement were both performed (13% versus 2.4%). This difference was not statistically significant. (Chi(2) = 3.41; p = 0.1). Bleeding was observed in one patient who underwent sphincterotomy and large-bore stent placement (2.4%). No perforations occurred in either group. CONCLUSIONS: Although not statistically significant, there is a higher rate of post-ERCP pancreatitis after placement of large-bore biliary stents when sphincterotomy is not performed. The additional complications of biliary sphincterotomy did not offset the reduction in post-ERCP pancreatitis. When large-bore biliary stents are used in the treatment of bile leak, a biliary sphincterotomy may avoid pancreatitis. Randomized trials are needed to determine whether there is a significant difference in overall complication rate when large-bore stents are placed with and without biliary sphincterotomy.
Authors: B Navez; D Mutter; Y Russier; M Vix; F Jamali; D Lipski; E Cambier; P Guiot; J Leroy; J Marescaux Journal: World J Surg Date: 2001-10 Impact factor: 3.352
Authors: Arthur John Kaffes; Luke Hourigan; Nicolas De Luca; Karen Byth; Stephen John Williams; Michael John Bourke Journal: Gastrointest Endosc Date: 2005-02 Impact factor: 9.427
Authors: Chi-Liang Cheng; Stuart Sherman; James L Watkins; Jeffrey Barnett; Martin Freeman; Joseph Geenen; Michael Ryan; Harrison Parker; James T Frakes; Evan L Fogel; William B Silverman; Kulwinder S Dua; Giuseppe Aliperti; Paul Yakshe; Michael Uzer; Whitney Jones; John Goff; Laura Lazzell-Pannell; Abdullah Rashdan; M'hamed Temkit; Glen A Lehman Journal: Am J Gastroenterol Date: 2006-01 Impact factor: 10.864
Authors: D J Bjorkman; D L Carr-Locke; D R Lichtenstein; A P Ferrari; A Slivka; J Van Dam; D C Brooks Journal: Am J Gastroenterol Date: 1995-12 Impact factor: 10.864
Authors: Piotr Paluszkiewicz; Wojciech Dudek; Najib Daulatzai; Andrzej Stanislawek; Colin Hart Journal: World J Surg Date: 2010-04 Impact factor: 3.352