Risk of pancreatitis following endoscopically placed large-bore plastic biliary stents with and without biliary sphincterotomy for management of postoperative bile leaks

Abstract

Although not statistically significant, there is a higher rate of post-ERCP pancreatitis after placement of large-bore biliary stents when sphincterotomy is not performed. The additional complications of biliary sphincterotomy did not offset the reduction in post-ERCP pancreatitis. When large-bore biliary stents are used in the treatment of bile leak, a biliary sphincterotomy may avoid pancreatitis. Randomized trials are needed to determine whether there is a significant difference in overall complication rate when large-bore stents are placed with and without biliary sphincterotomy.

Risk factors for pancreatitis following transpapillary self-expandable metal stent placement

“…Simmons et al [25] reported a higher rate of post-ERCP pancreatitis after placement of large-bore biliary stents wihout EST than with EST. In contrast, recent reports concluded that EST was not effective for the prevention of post-ERCP pancreatitis and was not necessary for transpapillary stenting using SEMS [7,15,21,26].…”

Endoscopic management of bile leaks after liver transplantation: An analysis of two high-volume transplant centers

“…36 In this study, the investigators identified a higher rate of post-ERCP pancreatitis after placement of large-bore biliary stents when sphincterotomy was not performed suggesting that sphincterotomy might be protective of post-ERCP pancreatitis when 10Fr stents are placed, and that otherwise sphincterotomy alone did not confer additional benefit for the treatment of bile leak. 36 Our findings confirm the results of a recent multicenter study of patients with post-cholecystectomy bile leaks. 37 In this study, 162 out of 178 patients (91%) had complete resolution of their bile leak after therapy with biliary sphincterotomy and biliary plastic stent placement.…”

Endoscopic management of biliary leak following gunshot wound to the liver

“…Although biliary sphincterotomy does not add additional drainage, data from our institution shows a reduced rate of pancreatitis when large-bore plastic stents are placed for bile leaks when sphincterotomy is performed. 2 …”