TRANSPAPILLARY STENTING OF PROXIMAL BILIARY STRICTURES - DOES BILIARYSPHINCTEROTOMY REDUCE THE RISK OF POSTPROCEDURE PANCREATITIS

Background Pancreatitis after biliary stenting is a rare complication. To reduce this risk, some endoscopists routinely perform biliary sphi ncterotomy before stenting, but the value of this practice is not esta blished. Methods: The incidence of pancreatitis was reviewed in patien ts undergoing biliary stenting with and without a biliary sphincteroto my. Results: Postprocedure pancreatitis occurred in 4 of 83 (4.8%) pat ients treated with transpapillary biliary stents. Patients with proxim al biliary strictures were at significantly increased risk for postpro cedure pancreatitis (4 of 24) versus those with distal or no stricture s (0 of 59) (p = 0.006). The four patients with pancreatitis after ste nting had not undergone sphincterotomy. Of those treated conservativel y, two cases were graded severe (one fatal), and one was mild. The oth er patient was markedly symptomatic from pancreatitis, but improved dr amatically after treatment with a needle-knife sphincterotomy done wit hin 24 hours of the original ERCP. Conclusion: The risk of pancreatiti s following transpapillary biliary stenting is increased in patients w ith proximal biliary strictures. Such lesions (malignant or benign) ma y serve as a fulcrum, leading to medial deflection of the stent and co mpression of the pancreatic orifice. The hypothesis that sphincterotom y may decrease the risk of biliary stent-induced obstructive pancreati tis should be tested in patients with proximal biliary strictures.