Abstract
Background
There is no consensus on the necessity of endoscopic sphincterotomy (ES) to prevent post-endoscopic retrograde cholangiopancreatography pancreatitis (PEP) after endoscopic stenting in patients with malignant biliary obstruction. We investigated the incidence of PEP after endoscopic biliary stenting for malignant biliary obstruction with or without ES in a multicenter prospective cohort study.
Methods
We enrolled 807 patients who underwent endoscopic biliary stenting for malignant biliary obstruction with a native papilla at 36 hospitals between April 2017 and March 2018. The incidence of PEP in patients with or without ES was compared for subgroups based on stent type, placement method, and patient background. Univariate and multivariate analysis was performed to investigate the incidence of PEP in all stenting patients.
Results
Plastic and metal stents (MS) were inserted in 598 and 209 patients, respectively. The incidence of PEP in patients with or without ES was 7.9% and 7.4%, respectively among all stenting patients. The incidences of PEP with or without ES in plastic stent insertion patients, patients with MS insertion, stent insertions across the papilla, stent insertions across the papilla in patients without main pancreatic duct obstruction, and fully covered MS insertions across the papilla were compared. There was no overall significant difference in the incidence of PEP between those with or without ES. Multivariate logistic regression analysis for the incidence of PEP in all stenting patients revealed obstruction of the main pancreatic duct at the pancreatic head and epinephrine spraying on the papilla were significant factors; there was no significant difference in the incidence of PEP between patients with or without ES.
Conclusion
Endoscopic sphincterotomy may not contribute to the prevention of PEP after endoscopic biliary stenting for malignant biliary obstruction, even in cases of insertion with a fully covered MS across the papilla.
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Acknowledgements
We thank all patients for participating in this cohort. The collaborators in the Bilio-pancreatic Study Group of West Japan were as follows: Keiji Hanada [Onomichi General Hospital]; Akihito Okazaki [Hiroshima Atomic Bomb Survivor Hospital]; Ken Hirao [Hiroshima City Hiroshima Citizens’ Hospital]; Hideki Kamada [Kagawa University]; Chishio Noguchi [Shin Beppu Hospital]; Daisuke Goto [Tottori Red Cross Hospital]; Ichro Moriyama [Shimane University Hospital]; Yoshinori Kushiyama [Matsue Red Cross Hospital]; Hidefumi Nishikiori [Oita Sanai Medical Center]; Kazuhiro Kamada [University Hospital Kyoto Prefectural University of Medicine]; Teru Kumagi [Ehime University Hospital]; Katsuhide Tanaka [Kita-Harima Medical Center]; Nobuaki Azemoto [Shikoku Cancer Center], Chisato Ishida [Tazuke Kofukai Medical Research Institute].
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Ryoji Takada has received honoraria for manuscript writing from Medicos Hirata, and honoraria for presentations from Teijin health care, Novartis pharma, and Hisamitsu pharmaceutical co. inc outside the submitted work. Hirofumi Kawamoto has received consulting fees from Gadelius Medical, Kaneka, Piloax, and J-MIT, and honoraria for lectures from Gadelius Medical, Kaneka, and Cook outside the submitted work. Hiroko Nebiki, Koichi Fujita, Shujiro Yazumi, Mamoru Takenaka, Toru Maruo, Kazuya Matsumoto, Masanori Asada, Takaaki Eguchi, Tokuhiri Matsuoka, Satoki Yasumura, Hisakazu Matsumoto, Takashi Tamura, Saiko Marui, Kazunori Hasegawa, Akira Mitoro, Atsuhiro Masuda, Ryuki Minami, Takeshi Ogura, Noriyuki Hoki, Eiji Funatsu, Akira Kurita, Takumi Onoyama, Takeshi Tomoda, Toshiharu Ueki, Tomoaki Yamasaki, Yuhei Sakata, Toshihiro Katayama, and Takashi Kawamura have no conflicts of interest or financial ties to disclose.
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Nebiki, H., Fujita, K., Yazumi, S. et al. Does endoscopic sphincterotomy contribute to the prevention of post-endoscopic retrograde cholangiopancreatography pancreatitis after endoscopic biliary stenting for malignant biliary obstruction? A multicenter prospective cohort study. Surg Endosc 37, 3463–3470 (2023). https://doi.org/10.1007/s00464-022-09823-5
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DOI: https://doi.org/10.1007/s00464-022-09823-5