Sa1487 Biliary Sphincterotomy Is Not Required for Bile Duct Stent Placement

Abstract

Endoscopic biliary sphincterotomy (EBS) is commonly performed prior to bile duct stent placement. However, bile duct stents can be deployed without EBS thereby minimizing the risk of post sphincterotomy bleeding. Over a 9 year period, all patients undergoing ERCP were prospectively identified. During this period, bile duct stent placement was routinely performed without EBS unless additional therapy (stone removal, multiple stenting) was anticipated. Following the procedure, all patients were followed-up at one and four weeks to assess for complications graded by consensus criteria. During the 105 month study period, 4193 patients underwent ERCP. Excluding patients with prior sphincterotomy or precut and those undergoing EBS for additional endoscopic therapy, bile duct stents were placed in 658 patients (42% female, 75% white, mean age 59 years). The most common indications for ERCP were: 40.3% jaundice, 14.7% pancreatic mass, and 8% bile leak after liver transplantation. Stent size was 80% 10 French, 20% 7 French with 15.1% metal stents). 160 of these patients underwent ERCP for stent exchange. Stents were successfully placed in all patients without the need for EBS. Comparing patients undergoing bile duct stenting with and without sphincterotomy, no difference was seen in rates of pancreatitis (1.31% vs 2.34% p=0.228) but post-sphincterotomy bleeding, generally mild to moderate, was noted in 17 of 1407 patients who did undergo EBS during the study period. Single bile duct stents, both plastic and metal, should be deployed without EBS unless additional endoscopic therapy is required.