Pancreatic stenting prevents pancreatitis after biliary sphincterotomy in patients with sphincter of oddi dysfunction

Background & Aims: Patients with sphincter of Oddi dysfunction are at high risk of developing pancreatitis after endoscopic biliary sphincterotomy. Im paired pancreatic drainage caused by pancreatic sphincter hypertension is t he likely explanation for this increased risk. A prospective, randomized co ntrolled trial was conducted to determine if ductal drainage with pancreati c stenting protects against pancreatitis after biliary sphincterotomy in pa tients with pancreatic sphincter hypertension. Methods: Eligible patients w ith pancreatic sphincter hypertension were randomized to groups with pancre atic duct stents (n = 41) or no stents (n = 39) after biliary sphincterotom y. The primary measured outcome was pancreatitis after endoscopic retrograd e cholangiopancreatography (ERCP). Results: Pancreatic stenting significant ly decreased the risk of pancreatitis from 26% to 7% (10 of 39 in the no st ent group and 3 of 41 in the stent group; P = 0.03). Only 1 patient in the stent group developed pancreatitis after sphincterotomy, and 2 others devel oped pancreatitis at the time of stent extraction. Patients in the no stent group were 10 times more likely to develop pancreatitis immediately after sphincterotomy than those in the stent group (relative risk, 10.5; 95% conf idence interval, 1.4-78.3). Conclusions: Pancreatic duct stenting protects significantly against post-ERCP pancreatitis in patients with pancreatic sp hincter hypertension undergoing biliary sphincterotomy. Stenting of the pan creatic duct should be strongly considered after biliary sphincterotomy for sphincter of Oddi dysfunction; pancreatic sphincter of Oddi manometry iden tifies which high-risk patients may benefit from pancreatic stenting.