The Safety Assessment of Percutaneous Transhepatic Transpapillary Stent Insertion in Malignant Obstructive Jaundice: Regarding the Risk of Pancreatitis and the Effect of Preliminary Endoscopic Sphincterotomy

Jeong, Young Wook; Shin, Kyong Deok; Kim, Seong Hun; Kim, In Hee; Kim, Sang Wook; Lee, Kyong Ae; Jeon, Byung Jun; Lee, Seung Ok

doi:10.4166/kjg.2009.54.6.390

Cited by 7 publications

(6 citation statements)

References 10 publications

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“…In our study, the incidence of PEP was 4.0% in hilar cholangiocarcinoma and 2.3% in distal cholangiocarcinoma. Although the outcomes with ES for malignant biliary strictures, especially cholangiocarcinoma, are controversial, several previous studies have demonstrated a lower incidence of PEP in the ES group compared to the non-ES group[8,9,31]. Jeong et al[8] investigated the risk of pancreatitis in patients with malignant obstructive jaundice following percutaneous or transpapillary stent placement.…”

Section: Discussionmentioning

confidence: 99%

“…They are, however, reported to be associated with a higher incidence of pancreatitis[6,7]. Previous studies indicate that performing endoscopic sphincterotomy (ES) before stent insertion may lower the incidence of post-ERCP pancreatitis (PEP)[8-10]. ES may also facilitate cannulation of the bile duct during difficult ERCPs, reduce resistance to the passage of stents, improve immediate stent deployment, and increase the luminal diameter of the distal common bile duct (CBD)[9-12].…”

Section: Introductionmentioning

confidence: 99%

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Efficacy and safety of limited endoscopic sphincterotomy before self-expandable metal stent insertion for malignant biliary obstruction

Nam

Kang

Kim

et al. 2017

WJG

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AIMTo evaluate the safety and efficacy of limited endoscopic sphincterotomy (ES) before placement of selfexpandable metal stent (SEMS). METHODSThis was a retrospective analysis of 244 consecutive patients with unresectable malignant biliary obstruction, who underwent placement of SEMSs following limited ES from December 2008 to February 2015. The diagnosis of malignant biliary obstruction and assessment of patient eligibility for the study was established by a combination of clinical findings, laboratory investigations, imaging and pathological results. All patients were monitored in the hospital for at least 24 h following endoscopic retrograde cholangio pancreatography (ERCP). The incidence of immediate or early post-ERCP complications such as post-ERCP pancreatitis (PEP) and bleeding related to limited ES were considered as primary outcomes. Also, characteristics and complications according to the cancer type were classified. RESULTSAmong the 244 patients included, the underlying diagnosis was cholangiocarcinoma in 118 patients, Core tip: The role of routine endoscopic sphincterotomy (ES) is still controversial in biliary stenting and there is a lack of systematic study for the extent of ES and its correlation with the incidence of complications. We retrospectively evaluated the safety and efficacy of limited ES before self-expandable metal stent insertion. We have proved in this study that limited ES doesn't increase the risk of post-procedure complications such as post-endoscopic retrograde cholangio pancreatography pancreatitis and bleeding. Also, it is advantageous in facilitating the more complex stenting procedures. Therefore, limited ES can be a safe, feasible, and effective therapeutic strategy in the placement of self-expandable metal stent.Nam HS, Kang DH, Kim HW, Choi CW, Park SB, Kim SJ, Ryu DG. Efficacy and safety of limited endoscopic sphincterotomy before self-expandable metal stent insertion for malignant biliary obstruction.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Efficacy and safety of limited endoscopic sphincterotomy before self-expandable metal stent insertion for malignant biliary obstruction

Nam

Kang

Kim

et al. 2017

WJG

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“…Results of reports of pancreatitis and stent migration following placement of a metal stent are shown in Table . Jeong et al .…”

Section: Placement Of a Metal Stentmentioning

confidence: 99%

“…Jeong et al . retrospectively studied 90 patients that underwent percutaneous placement or transpapillary placement . They noted pancreatitis in many of the patients that underwent percutaneous placement (odds ratio: 1.87, 95% CI: 0.516–6.761) and in a few of the patients that underwent EST and transpapillary placement (odds ratio: 0.91, 95% CI: 0.656–1.273), but the differences were not statistically significant.…”

Section: Placement Of a Metal Stentmentioning

confidence: 99%

“…Among plastic stents, a 10 Fr is often used, and endoscopic sphincterotomy (EST) is often carried out to facilitate insertion . A report has indicated that EST is effective for preventing postoperative pancreatitis when placing a metal stent, but its effect is still being debated. In addition, EST, itself, involves risks of early complications such as bleeding and perforation .…”

Section: Introductionmentioning

confidence: 99%

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Necessity for endoscopic sphincterotomy for biliary stenting in cases of malignant biliary obstruction

Okano

Igarashi

Kishimoto

et al. 2013

Digestive Endoscopy

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Endoscopic biliary stenting is a useful way to treat distal malignant biliary strictures that are not eligible for surgery. A 10-Fr plastic or metal stent is used for stenting. Typically, endoscopic sphincterotomy (EST) has often been carried out as a way to prevent pancreatitis after stent placement given the ease of stent insertion, but EST has flaws such as bleeding and stent migration.The present study describes the need for EST prior to stent placement.

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Comparison of axial force and cell width of self‐expandable metallic stents: which type of stent is better suited for hilar biliary strictures?

Mukai

Yasuda

Isayama

et al. 2011

J Hepato Biliary Pancreat

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Background Various types of self-expandable metallic stents (SEMSs) are commercially available. However, few reports have compared the performance of the various SEMSs. In addition to long-term patency, maneuverability during initial placement and feasibility of re-intervention for the stent occlusion are also very important. Methods In this retrospective analysis, we compared the duration of stent patency and frequency of re-interventions in 96 patients diagnosed with unresectable hilar biliary strictures in whom initial 10-mm SEMSs were inserted between June 1999 and November 2008. Results Based on Kaplan-Meier curves, significantly shorter patency duration was noted for SEMSs with moderate axial force (AF) than for other groups of SEMSs with low AF. Endoscopic re-interventions for SEMS occlusion were easier in a group of SEMSs with low AF and large cell width than in other groups of SEMSs. Conclusions With respect to patency duration and the frequency of re-intervention required, we consider that SEMSs with low AF and large cell width are favorable for hilar biliary strictures.

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The Safety Assessment of Percutaneous Transhepatic Transpapillary Stent Insertion in Malignant Obstructive Jaundice: Regarding the Risk of Pancreatitis and the Effect of Preliminary Endoscopic Sphincterotomy

Abstract: Metallic stent insertion through the intact sphincter of Oddi might have a risk of developing pancreatitis. Further study is needed to elucidate the mechanism of pancreatitis and the way of prevention.

Cited by 7 publications

References 10 publications

Efficacy and safety of limited endoscopic sphincterotomy before self-expandable metal stent insertion for malignant biliary obstruction

Efficacy and safety of limited endoscopic sphincterotomy before self-expandable metal stent insertion for malignant biliary obstruction

Necessity for endoscopic sphincterotomy for biliary stenting in cases of malignant biliary obstruction

Comparison of axial force and cell width of self‐expandable metallic stents: which type of stent is better suited for hilar biliary strictures?

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