Document Detail


Transpapillary stenting of proximal biliary strictures: does biliary sphincterotomy reduce the risk of postprocedure pancreatitis?
MedLine Citation:
PMID:  9013169     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Pancreatitis after biliary stenting is a rare complication. To reduce this risk, some endoscopists routinely perform biliary sphincterotomy before stenting, but the value of this practice is not established. METHODS: The incidence of pancreatitis was reviewed in patients undergoing biliary stenting with and without a biliary sphincterotomy. RESULTS: Postprocedure pancreatitis occurred in 4 of 83 (4.8%) patients treated with transpapillary biliary stents. Patients with proximal biliary strictures were at significantly increased risk for postprocedure pancreatitis (4 of 24) versus those with distal or no strictures (0 of 59) (p = 0.006). The four patients with pancreatitis after stenting had not undergone sphincterotomy. Of those treated conservatively, two cases were graded severe (one fatal), and one was mild. The other patient was markedly symptomatic from pancreatitis, but improved dramatically after treatment with a needle-knife sphincterotomy done within 24 hours of the original ERCP. CONCLUSION: The risk of pancreatitis following transpapillary biliary stenting is increased in patients with proximal biliary strictures. Such lesions (malignant or benign) may serve as a fulcrum, leading to medial deflection of the stent and compression of the pancreatic orifice. The hypothesis that sphincterotomy may decrease the risk of biliary stent-induced obstructive pancreatitis should be tested in patients with proximal biliary strictures.
Authors:
P R Tarnasky; J T Cunningham; R H Hawes; B J Hoffman; R Uflacker; I Vujic; P B Cotton
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Publication Detail:
Type:  Case Reports; Journal Article; Review    
Journal Detail:
Title:  Gastrointestinal endoscopy     Volume:  45     ISSN:  0016-5107     ISO Abbreviation:  Gastrointest. Endosc.     Publication Date:  1997 Jan 
Date Detail:
Created Date:  1997-05-01     Completed Date:  1997-05-01     Revised Date:  2005-11-16    
Medline Journal Info:
Nlm Unique ID:  0010505     Medline TA:  Gastrointest Endosc     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  46-51     Citation Subset:  IM    
Affiliation:
Medical University of South Carolina, Digestive Disease Center, Charleston, USA.
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Bile Duct Diseases / diagnosis,  surgery*
Cholangiopancreatography, Endoscopic Retrograde / adverse effects*,  methods
Female
Humans
Male
Pancreatitis / etiology,  prevention & control*
Prognosis
Risk Factors
Sphincterotomy, Endoscopic / instrumentation*,  methods
Stents / adverse effects*

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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