Digestive Diseases and Sciences

, Volume 56, Issue 2, pp 591–595 | Cite as

Endoscopic Biliary Sphincterotomy Is Not Required for Transpapillary SEMS Placement for Biliary Obstruction

  • Nikhil Banerjee
  • Kristen Hilden
  • Todd H. Baron
  • Douglas G. AdlerEmail author
Original Article



Endoscopic retrograde cholangiopancreatography with biliary self-expanding metal stent placement is the preferred method of providing biliary drainage for pancreaticobiliary malignancies. Some endoscopists routinely perform biliary sphincterotomy to facilitate biliary stent placement and potentially minimize pancreatitis with transpapillary self-expanding metal stent placement.


Our hypothesis was that biliary sphincterotomy has no effect on the success rate of transpapillary self-expanding metal stent placement and increases procedure-related complications.


In a retrospective analysis, outcomes of two groups were compared: (1) self-expanding metal stent placement without biliary sphincterotomy, (2) self-expanding metal stent placement with biliary sphincterotomy during the same procedure. Complications and stent patency rates were evaluated.


There were 104 subjects included in the study. Post-sphincterotomy bleeding (p = 0.001) was associated with biliary sphincterotomy performed immediately prior to self-expanding metal stent placement. Importantly, self-expanding metal stent placement without biliary sphincterotomy was always technically successful and self-expanding metal stent placement without biliary sphincterotomy was not associated with pancreatitis.


Patients who undergo biliary sphincterotomy during transpapillary self-expanding metal stent placement experience more immediate complications than those who do not. Biliary sphincterotomy was not associated with longer stent patency. Self-expanding metal stent placement without a biliary sphincterotomy was not associated with pancreatitis regardless of the type of self-expanding metal stent used (covered or uncovered). Of the patients without a biliary sphincterotomy, 100% had successful stent placement, further arguing against its use in this setting.


ERCP Pancreas Endoscopy Complications Pancreatitis Sphincterotomy 


  1. 1.
    Giorgio PD, Luca LD. Comparison of treatment outcomes between biliary plastic stent placements with and without endoscopic sphincterotomy for inoperable malignant common bile duct obstruction. World J Gastroenterol. 2004;10(8):1212–1214.PubMedGoogle Scholar
  2. 2.
    Moss AC, Morris E, Mac Mathuna P. Palliative biliary stents for obstructing pancreatic carcinoma. Cochrane Database Syst Rev. 2006 Apr 19;(2):CD004200. Review.Google Scholar
  3. 3.
    Yoon WJ, Lee JK, Lee KH, et al. A comparison of covered and uncovered Wallstents for the management of distal malignant biliary obstruction. Gastrointest Endosc. 2006;63(7):996–1000.CrossRefPubMedGoogle Scholar
  4. 4.
    Freeman ML, Nelson DB, Sherman S, et al. Complication of endoscopic biliary sphincterotomy. N Engl J Med. 1996;335:909–918.CrossRefPubMedGoogle Scholar
  5. 5.
    Folkers MT, Disario JA, Adler DG. Long-term complications of endoscopic biliary sphincterotomy for choledocholithiasis: a North-American perspective. Am J Gastroenterol. 2009;104(11):2868–2869.CrossRefPubMedGoogle Scholar
  6. 6.
    Cotton PB, Lehman G, Vennes J, et al. Endoscopic sphincterotomy complications and their management: an attempt at consensus. Gastrointest Endosc. 1991;37(3):383–393.CrossRefPubMedGoogle Scholar
  7. 7.
    Anderson MA, Ben-Menachem T, Gan SI, et al. Management of antithrombotic agents for endoscopic procedures. Gastrointest Endosc. 2009;70(6):1060–1070.CrossRefPubMedGoogle Scholar
  8. 8.
    Caddy GR, Tham TC. Gallstone disease: symptoms, diagnosis and endoscopic management of common bile duct stones. Best Pract Res Clin Gastroenterol. 2006;20(6):1085–1101.CrossRefPubMedGoogle Scholar
  9. 9.
    Tai CK, Tang CN, Ha JP, Chau CH, Siu WT, Li MK. Laparoscopic exploration of common bile duct in difficult choledocholithiasis. Surg Endosc. 2004 Jun; 18(6):910–914. Epub 2004 Apr 21.Google Scholar
  10. 10.
    Wang AY, Ellen K, Berg CL, Schmitt TM, Kahaleh M. Fully covered self-expandable metallic stents in the management of complex biliary leaks: preliminary data—a case series. Endoscopy. 2009;41(9):781–786.CrossRefPubMedGoogle Scholar
  11. 11.
    Loperfido S, Angelini G, Benedetti G, et al. Major early complications from diagnostic and therapeutic ERCP: a prospective multicenter study. Gastrointest Endosc. 1998;48(1):1–10.CrossRefPubMedGoogle Scholar
  12. 12.
    Saeed M, Kadir S, Kaufman SL, Murray RR, Milligan F, Cotton PB. Bleeding following endoscopic sphincterotomy: angiographic management by transcatheter embolization. Gastrointest Endosc. 1989;35(4):300–303.CrossRefPubMedGoogle Scholar
  13. 13.
    Sherman S, Hawes RH, Nisi R, Lehman GA. Endoscopic sphincterotomy-induced hemorrhage: treatment with multipolar electrocoagulation. Gastrointest Endosc. 1992;38(2):123–126.CrossRefPubMedGoogle Scholar
  14. 14.
    Geenen JE, LoGuidice JA. Endoscopic sphincterotomy for diseases of the biliary tree. Adv Surg. 1980;14:31–51.PubMedGoogle Scholar
  15. 15.
    Ornellas LC, Stefanidis G, Chuttani R, Gelrud A, Kelleher TB, Pleskow DK. Covered Wallstents for palliation of malignant biliary obstruction: primary stent placement versus reintervention. Gastrointest Endosc. 2009 Oct; 70(4):676–683. Epub 2009 Jun 26.Google Scholar
  16. 16.
    Isayama H, Komatsu Y, Tsujino T, et al. Polyurethane-covered metal stent for management of distal malignant biliary obstruction. Gastrointest Endosc. 2002;55(3):366–370.CrossRefPubMedGoogle Scholar
  17. 17.
    Kahaleh M, Tokar J, Conaway MR, et al. Efficacy and complications of covered Wallstents in malignant distal biliary obstruction. Gastrointest Endosc. 2005;61(4):528–533.CrossRefPubMedGoogle Scholar
  18. 18.
    Artifon EL, Sakai P, Ishioka S, et al. Endoscopic sphincterotomy before deployment of covered metal stent is associated with greater complication rate: a prospective randomized control trial. J Clin Gastroenterol. 2008;42(7):815–819.CrossRefPubMedGoogle Scholar
  19. 19.
    Isayama H, Komatsu Y, Tsujino T, et al. A prospective randomised study of “covered” versus “uncovered” diamond stents for the management of distal malignant biliary obstruction. Gut. 2004;53(5):729–734.CrossRefPubMedGoogle Scholar
  20. 20.
    Thurnher SA, Lammer J, Thurnher MM, Winkelbauer F, Graf O, Wildling R. Covered self-expanding transhepatic biliary stents: clinical pilot study. Cardiovasc Intervent Radiol. 1996;19(1):10–14.CrossRefPubMedGoogle Scholar
  21. 21.
    Miyayama S, Matsui O, Terayama N, Tatsu H, Yamamoto T, Takashima T. Covered Gianturco stents for malignant biliary obstruction: preliminary clinical evaluation. J Vasc Interv Radiol. 1997;8(4):641–648.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  • Nikhil Banerjee
    • 1
  • Kristen Hilden
    • 1
  • Todd H. Baron
    • 2
  • Douglas G. Adler
    • 1
    Email author
  1. 1.Division of Gastroenterology and Hepatology, Huntsman Cancer CenterUniversity of Utah School of MedicineSalt Lake CityUSA
  2. 2.Division of Gastroenterology and HepatologyMayo ClinicRochesterUSA

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