The risk of post ERCP pancreatitis with and without sphincterotomy in patients undergoing biliary stent placement

Background:Endoscopic Sphincterotomy (ES) prior to the placement of biliary stent is frequently performed,however, data evaluating the utility and complications of this approach are limited.Our aim was to compare post ERCP complications in patients who underwent biliary stent insertion with and without ES. Methods:All patients undergoing stent placement from 1989 to 1995 were evaluated.Data collected included patient demographics,procedural indication,stent size,antecedent endoscopic therapy and ES and stent related complications. Patients with prior biliary sphinterotomy and with pancreatic stems were excluded. Results:Among the 148 patients (76 M, 72 F) who underwent stent placement over a 6 year period 61 patients underwent ES at the time of stent placement, 87 patients had stent placed without sphincterotomy. The groups were matched for age, sex, procedural indication and stent size. Eight patients (5.4%) had complications requiring hospitalization. There was no procedure related perforation or death. Stent w/ES, Stent only P value Total patients Complications n=61 n=87 Bleeding 3(4.9%) - ns Pancreatitis - 2(2.3%) ns Abdominal pain 1(1.6%) 2(2.3%) ns Total 4 4 ns Conclusions: There was no statistically significant difference in the rate of complications in patients undergoing biliary stent placement with or without sphincterotomy ES at the time of stent placement does not decrease the risk ofpost ERCP pancreatitis and is not necessary for routine biliary stent placement.