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Does endoscopic sphincterotomy reduce the risk of post-endoscopic retrograde cholangiopancreatography pancreatitis after biliary stenting? A systematic review and meta-analysis.
Dig Endosc 2016; 28(4):394-404DE

Abstract

BACKGROUND AND AIM

Endoscopic biliary sphincterotomy (ES) is often carried out prior to placement of a biliary stent apparently to reduce the risk of post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP). However, the protective effect of ES prior to biliary stenting is controversial. The objective of this meta-analysis is to compare the risk of PEP and other complications after the placement of biliary stent with or without ES in patients with biliary obstruction and bile leak.

METHODS

We carried out a systematic search in several electronic databases for randomized controlled trials (RCT) and observational studies (OS) comparing the risk of PEP after biliary stenting with or without ES. The Mantel-Haenszel method was used to pool data of adverse outcomes into fixed or random effect model meta-analyses.

RESULTS

Seventeen studies (five RCT and 12 OS) with a total of 2710 patients met the inclusion criteria. No significant difference was observed in the risk of PEP with biliary stenting with and without ES (RD -0.01; 95% confidence interval [CI] -0.03, 0.01). In a subgroup analysis of stenting for biliary obstruction, no difference in the risk of PEP was observed with or without ES. However, ES was associated with lower risk of PEP in patients undergoing biliary stenting for bile leak (RD -0.05; CI -0.10, -0.01).

CONCLUSIONS

ES shows risk reduction in prevention of PEP in patients undergoing endoscopic stenting for bile leak. However, placement of biliary stent without ES is not associated with an increased risk of PEP in patients with distal bile duct obstruction with involvement of pancreatic duct.

Authors+Show Affiliations

Departments of Medicine, Division of Gastroenterology, University of Toledo Medical Center, Toledo, USA.Departments of Medicine, Division of Gastroenterology, University of Toledo Medical Center, Toledo, USA.Departments of Medicine, Division of Gastroenterology, University of Toledo Medical Center, Toledo, USA.Departments of Internal Medicine, University of Toledo Medical Center, Toledo, USA.Departments of Medicine, Division of Gastroenterology, University of Toledo Medical Center, Toledo, USA.Departments of Internal Medicine, University of Toledo Medical Center, Toledo, USA.

Pub Type(s)

Journal Article
Meta-Analysis
Review
Systematic Review

Language

eng

PubMed ID

26636754

Citation

Sofi, Aijaz Ahmed, et al. "Does Endoscopic Sphincterotomy Reduce the Risk of Post-endoscopic Retrograde Cholangiopancreatography Pancreatitis After Biliary Stenting? a Systematic Review and Meta-analysis." Digestive Endoscopy : Official Journal of the Japan Gastroenterological Endoscopy Society, vol. 28, no. 4, 2016, pp. 394-404.
Sofi AA, Nawras A, Alaradi OH, et al. Does endoscopic sphincterotomy reduce the risk of post-endoscopic retrograde cholangiopancreatography pancreatitis after biliary stenting? A systematic review and meta-analysis. Dig Endosc. 2016;28(4):394-404.
Sofi, A. A., Nawras, A., Alaradi, O. H., Alastal, Y., Khan, M. A., & Lee, W. M. (2016). Does endoscopic sphincterotomy reduce the risk of post-endoscopic retrograde cholangiopancreatography pancreatitis after biliary stenting? A systematic review and meta-analysis. Digestive Endoscopy : Official Journal of the Japan Gastroenterological Endoscopy Society, 28(4), pp. 394-404. doi:10.1111/den.12584.
Sofi AA, et al. Does Endoscopic Sphincterotomy Reduce the Risk of Post-endoscopic Retrograde Cholangiopancreatography Pancreatitis After Biliary Stenting? a Systematic Review and Meta-analysis. Dig Endosc. 2016;28(4):394-404. PubMed PMID: 26636754.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Does endoscopic sphincterotomy reduce the risk of post-endoscopic retrograde cholangiopancreatography pancreatitis after biliary stenting? A systematic review and meta-analysis. AU - Sofi,Aijaz Ahmed, AU - Nawras,Ali, AU - Alaradi,Osama Habib, AU - Alastal,Yaseen, AU - Khan,Muhammed Ali, AU - Lee,Wade M, Y1 - 2016/02/03/ PY - 2015/07/21/received PY - 2015/11/12/revised PY - 2015/11/30/accepted PY - 2015/12/5/entrez PY - 2015/12/5/pubmed PY - 2018/3/17/medline KW - ERCP KW - acute pancreatitis KW - biliary stents KW - complications KW - sphincterotomy SP - 394 EP - 404 JF - Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society JO - Dig Endosc VL - 28 IS - 4 N2 - BACKGROUND AND AIM: Endoscopic biliary sphincterotomy (ES) is often carried out prior to placement of a biliary stent apparently to reduce the risk of post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP). However, the protective effect of ES prior to biliary stenting is controversial. The objective of this meta-analysis is to compare the risk of PEP and other complications after the placement of biliary stent with or without ES in patients with biliary obstruction and bile leak. METHODS: We carried out a systematic search in several electronic databases for randomized controlled trials (RCT) and observational studies (OS) comparing the risk of PEP after biliary stenting with or without ES. The Mantel-Haenszel method was used to pool data of adverse outcomes into fixed or random effect model meta-analyses. RESULTS: Seventeen studies (five RCT and 12 OS) with a total of 2710 patients met the inclusion criteria. No significant difference was observed in the risk of PEP with biliary stenting with and without ES (RD -0.01; 95% confidence interval [CI] -0.03, 0.01). In a subgroup analysis of stenting for biliary obstruction, no difference in the risk of PEP was observed with or without ES. However, ES was associated with lower risk of PEP in patients undergoing biliary stenting for bile leak (RD -0.05; CI -0.10, -0.01). CONCLUSIONS: ES shows risk reduction in prevention of PEP in patients undergoing endoscopic stenting for bile leak. However, placement of biliary stent without ES is not associated with an increased risk of PEP in patients with distal bile duct obstruction with involvement of pancreatic duct. SN - 1443-1661 UR - https://www.unboundmedicine.com/medline/citation/26636754/Does_endoscopic_sphincterotomy_reduce_the_risk_of_post_endoscopic_retrograde_cholangiopancreatography_pancreatitis_after_biliary_stenting_A_systematic_review_and_meta_analysis_ L2 - https://doi.org/10.1111/den.12584 DB - PRIME DP - Unbound Medicine ER -